Birth Control 101: Find the Method That’s Perfect For You

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Whether you’re in your teens and having babies is the furthest thing from your mind, in your thirties and trying to space out your pregnancies, or nearing menopause, there’s a birth control option that’s perfect for you. The trick is sorting through all of the myriad choices in order to find it. One Medical Group physician Natasha Withers, DO, runs through the options and helps take the mystery out of the process of trying not to get pregnant.

Hormonal methods

Options

The birth control pill, the ring, the patch, injectable forms

How They Work

Hormone-based birth control methods use hormones–typically a combination of estrogen and progesterone–to trick your ovaries into not releasing eggs.

Pros and Cons

Whether you take hormonal birth control in a pill or some other form, the upsides, as well as the potential risks and downsides, are similar. “All will give you a very predictable menstrual cycle, and for those who normally have very heavy or crampy periods and PMS symptoms, these methods will help,” explains Withers.

Potential side effects include an increased–though very rare–risk of blood clots, heart attack, and stroke. “These risks are higher for women who are over 35, especially if you smoke,” says Withers.

A Closer Look

The Pill: This is the most commonly used form of hormonal birth control, and it’s the one that has been around the longest. Typically, you take a pill daily (at approximately the same time each day to maximize its effectiveness) for three weeks straight. Then during the fourth week, you take a daily placebo (sugar pill) and during that week you will get your period.

Continuous-dose Pill: Pills such as Seasonale are taken continuously throughout the month without a placebo. This type of pill ensures that that you only get your period four times a year. Actually, any birth control pill can be used this way. You just skip the week of sugar pills and roll right into the next pack of active pills. But newer brands are marketed specifically for this type of use.”It’s a great option for women who have problems–like acne breakouts or depression–around their periods,” says Withers. The downside is that you are more likely to experience breakthrough bleeding between periods than you are on a regular monthly pill. But after a few months of taking a continuous dose pill, the risk of breakthrough bleeding should subside.

The Patch: If you’d rather not have to remember to take a daily pill, a patch like the Ortho Evra is a good option. It delivers a similar combination of hormones directly into the skin. The downside is that you do have to wear it on your skin, but you can place the patch somewhere unobtrusive–like your buttocks–and it’s safe to swim, shower, and bathe with it on. It needs to be replaced once a week for three weeks, then on the fourth week you skip the patch and get your period.

The Ring: This is the newest entry in the hormonal birth control category. This soft, flexible ring is inserted into the vagina and stays there for three weeks (you then remove it for a week and have your period). “It’s not difficult to insert or remove and you really can’t do it wrong,” says Withers. And if it gets dislodged and falls out, you can simply reinsert it. Most partners will not feel it during intercourse, but according to Withers, it can be removed for up to two hours without affecting its effectiveness if it bothers your partner.

Progesterone-only methods

There are some women for whom estrogen isn’t recommended: those with high blood pressure, smokers, anyone who’s had a blood clot before, women who are currently breastfeeding, or those who are prone to migraine headaches. And for them, the best hormonal birth control options are those that contain only progesterone.

A Closer Look

Progesterone-only Pill: Also known as “the Mini-Pill,” the progesterone-only pill is less frequently prescribed because it needs to be taken at the exact same time every day. “There’s no window,” says Withers. “You have to take it at the same time each day or it’s not effective.” It’s designed to be taken continuously, so you won’t get a regular period (but may experience some spotting).

Depo Provera: This progesterone injection must be administered by your doctor every 12 weeks. The upside is that you don’t have to take anything or do anything in between those shots, and your period will be either eliminated or just very light. But there are several downsides–it decreases bone density (you’ll need to take extra calcium to help counteract), it can cause weight gain, and it can take up to a year and a half to get your regular ovulation cycle back after you stop using it. “For that reason, it’s best for those who aren’t planning to get pregnant at all,” says Withers.

Implanon: This method involves having a hormone-releasing rod implanted in the upper arm. Usually you can’t see it once it’s there, and it can stay in for up to three years. It may eliminate your periods, but it may also cause weight gain. Like the injections, this method is best for someone who isn’t planning to get pregnant anytime soon.

Intrauterine Devices (IUDs)

Options

Paraguard, Mirena

How They Work

This birth control method involves having a T-shaped device inserted into the uterus by a health care provider. IUDs change the cervical mucous so that sperm are inactivated before they can reach the egg. (You won’t actually notice any changes–such as dryness–to your cervical fluid.)

Pros and Cons

IUDs fell out of favor in the ’70s because they became associated with health problems such as miscarriages and infections. “But the ones on the market now–which have been available for the past 20 years–don’t increase your risk of infection and can be used whether or not you’ve already had a child,” says Withers. “They are my favorite method of birth control–great for anyone from teens to women who are between pregnancies or those nearing menopause.” And while an IUD can stay in place for several years, an IUD won’t affect fertility once it’s removed.

A Closer Look

Paraguard: This is a copper IUD that contains no hormones. Once it’s inserted by your health care provider, the Paraguard can stay in for up to 12 years. During that time you will get a monthly period, and it can make those periods heavier, with worse cramps. But if you like the reassurance of getting a monthly period and you prefer not to use hormones, this is a good option (especially for women who normally don’t have problematic menstrual cycles).

Mirena: This version of the IUD releases a small amount of progesterone. But unlike other progesterone-based birth control methods, the hormone in the IUD acts locally rather than systemically, so it causes fewer negative side effects and is safe for women who are breastfeeding. It can stay in place for up to seven years. Thanks to the progesterone, your period will be very light or completely eliminated.

Barrier methods

Options

Male condom, female condom, diaphragm, cervical cap

How They Work

All of these birth control options work by blocking sperm from passing through the cervix.

Pros and Cons

They are the least effective birth control method and require inserting or putting on before each act of intercourse. They are best for those who don’t want to use a hormonal method and who only need occasional protection.

A Closer Look

Male condom: The biggest advantage of male condoms is that they protect both partners from the transmission of sexually transmitted diseases, including HIV.

Female condom: These also protect against STDs, but they are not very commonly available, awkward to insert and noisy during intercourse. Withers says that patients who’ve tried them say it sounds like “the crunching of a plastic bag.”

Diaphragm: The diaphragm must be used with spermicide and has to be inserted before sex and left in place for several hours afterward. It has to be fitted by a doctor and must be re-fitted if you gain or lose weight or after pregnancy. Getting it into properly into place against the cervix (and removing it later) can be awkward and takes a bit of practice.

Cervical cap: Like a diaphragm, this is inserted into the vagina and placed over the cervix. Because it is smaller than a diaphragm, it is designed to cover just the cervix and is held in place by suction. It also needs to be used with spermicide and must stay in place for several hours after intercourse.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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