Birth control is changing
How do you choose the method that’s right for you?
Vikki Mioduszewski Published: 11/28/2018
Forty years ago, birth control was pretty straightforward. There was the pill, IUDs, diaphragms and condoms.
Today there’s the pill, the patch, the ring, the shot, the implant, and a plethora of hormonal and non-hormonal IUDs. Are they safe? Are they effective? Why pick one instead of another?
“The right decision is very much dependent on the woman you’re speaking with,” said Kelley Stoddard, MD, an obstetrician and gynecologist with North Florida OB/GYN who delivers at Baptist Medical Center South. “There’s no cookie-cutter way to do it. You have to individualize it to each patient.”
Narrowing down the options
A simple way to begin is by starting with what you’ve already used, said Christina Adams, MD, an obstetrician and gynecologist with North Florida OB/GYN who delivers at Baptist Beaches.
“If a woman is happy with what she is using, then I say let’s not fix what’s not broken,” she said. “The best birth control method is the method you will consistently use.”
Most women begin with the pill. That’s because most start using birth control as teenagers.
“It’s what their friends use, it’s what their moms have experienced, and it’s what they’re comfortable with,” Dr. Adams said.
After that, if a woman doesn’t like her current birth control method, Dr. Adams will narrow down what she didn’t like about it and find another method that will get rid of the problem.
Choices guided by health conditions, goals and lifestyle
Dr. Stoddard begins by ruling out any birth control method a woman shouldn’t use because of her personal or family medical history.
If she or a family member has a history of blood clots, Dr. Stoddard will steer her away from the pill, the patch and the NuvaRing® because they all contain estrogen.
“Estrogen and blood clotting disorders don’t mix,” Dr. Stoddard said, “because estrogen-containing birth control can increase your risk for blood clots.”
Smoking increases the risk of blood clots, too, and women over 35 who smoke shouldn’t use medication with estrogen at all.
After that, Dr. Stoddard considers a woman’s goals and her lifestyle.
Besides preventing pregnancy, does she want to even out irregular cycles? Lighten or eliminate her period altogether? The pill and other hormonal birth control methods are able to do both of these things.
A woman’s habits also come into play.
“Some women are very bad pill takers and they’re not going to take a pill every day,” Dr. Stoddard said.
For them, long-acting medications work better. The patch and the NuvaRing® deliver the same hormones as the pill, but are replaced every week and every month respectively. Nexplanon®, a small device inserted in the arm by a physician or other health care provider, releases hormones for three years. And an IUD can last five to 10 years.
Side effects may factor in
Some women don’t like the side effects of their birth control method. It’s the main reason women come to Dr. Adams wanting a change. Some get headaches, nausea, anxiety or mood swings from hormones. Others get excessive cramping or heavier periods from IUDs.
“Some women don’t like any birth control they try,” Dr. Adams said. “So then you’ve got condoms and spermicide. The old-fashioned birth control methods still work if you use them regularly and in the right way.”
Bothersome side effects of the pill have been decreasing over the years as medical science has learned that the medication is still effective at much lower hormone doses.
“Thirty-five micrograms used to be a low-dose pill,” Dr. Stoddard said. “Now it’s the highest dose you can get.”
Biggest changes: No more periods and long-lasting birth control
One of the most dramatic changes in birth control has been the rise of long-acting, reversible contraception, Dr. Adams said. That includes the Nexplanon® implant and IUDs. The failure rates of these methods are lower than the pill, about 0.1 percent compared to 1 percent, because of less user error.
"If you have to take a pill every day, it’s easy to miss one.” Dr. Adams said.
Another practice on the rise is getting rid of having a period altogether, Dr. Stoddard said. Women have active lifestyles. Some want to control if and when they have their periods, so they don’t worry about their cycle while they’re on vacation or on their wedding day.
“Most female OB/GYNs use some sort of method that makes their periods go away,” Dr. Stoddard said, “because, you can do it. It’s safe. And why have a period if you don’t need to?”