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Finding the birth control that's best for you

November 28, 2017 | UC Irvine Health
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Women today have more choices than ever for birth control. Some contraceptives are hormonal, some not. Some last for years, others you must remember to take daily.

Still others require an office visit, while some are available without a prescription. Then there’s the cost. Oh, and there’s the matter of effectiveness. . .

How’s a woman to decide?

“When women come in for counseling, I usually give them the three main choices from which to start the discussion: prescriptions requiring frequent administrations, or clinician-placed devices, or. self-administered over-the-counter options,” said Dr. Baotran N. Vo, a family medicine physician with an emphasis in women’s health issues who practices in UC Irvine Health Gottschalk Medical Plaza in Irvine.

“It’s usually very easy for women to decide — women often feel very strongly about what kind of birth control is right for them.”

She offered her insights on the main types of birth control and their pros and cons:

Pill, patch, ring and injection birth control

These all involve hormones, either progestin alone (P) or estrogen and progesterone (E-P) combined.

  • The pill (P, E-P), which is taken once a day, comes in progestin alone or in estrogen-progesterone combination. It can help reduce painful periods and anemia. Research suggests that the combination pill not only helps control acne but also reduces the risk of cancer of the cervix, ovary and colon. Because you have to remember to take it every day, it’s only the third most-effective method.
  • The patch (E-P) is worn for three weeks, then taken off for one week. Its pros are similar to the pill’s, and it’s about equally as effective.
  • The ring (E-P) is placed vaginally by the woman for three weeks, then off for one week.
  • The injection (P) is given in the arm every three months. It contains progesterone so it will not help with acne, and has the same pros as the pill and patch. It’s the second most-effective method of birth control, but it requires an office visit. Some women have reported average weight gain of no more than five pounds, which has not been documented with the pill, patch or ring. It may take longer to resume fertility once a woman stops her injection; the average is 10 months to acheive pregnancy after stopping the injection)/

Long-acting reversible contraception (LARC)

These are the most long-acting and the most effective methods. All require insertion and removal by a health professional. Most employ hormones, but not all.

Some women experience adjustment periods of three to six and even to 12 months, with cramping and irregular periods, but experience lighter periods or no period at all after that adjust period.

They are easily reversible, and most women return to normal fertility within a week after removal.

  • Nexplanon: Implant of a small, single toothpick-sized rod under the skin in the upper arm, releases progestin to protect against pregnancy for up to three years.
  • Hormonal IUDs (Skyla, Liletta, Kyleena and Mirena): These intrauterine devices are inserted into the uterus and use progestin to provide protection for up to three, four, five and six years respectively.
  • Non-hormonal ParaGard IUD: This non-hormonal device consists of a copper wire wrapping around a plastic device inserted in the uterus that protects against pregnancy for 10 to 12 years.

Barrier contraceptive devices

These devices are the fourth most effective type of contraction. Most can be purchased over the counter, and the woman controls when to use them. Most can be inserted ahead of time and can remain in place for up to 30 hours.

  • Male condoms do not require a prescription. They are for one-time use, and they offer some protection against sexually transmitted diseases (STDs).
  • Female condoms do not require a prescription. They are for one-time use, and they help prevent STDs. 
  • Diaphragm and cervical cap can be washed and reused. They do not protect against STDs.
  • Sponges are for one-time use and contain spermicide to kill the sperm. They do not protect against STDs.

Other birth control methods 

There are other, less-effective choices, such as spermicides and the rhythm method.

Emergency contraception for use within three to five days after intercourse is also an option that women can purchase without a prescription (Plan B) or discuss with their physicians.

Although the choice of contraception is as diverse as the women who make the choices, Vo began noticing a trend toward LARCs that started before the most recent presidential election.

“With the fear that the Affordable Care Act would end,” Vo says, “a lot of women began opting for the long-lasting LARCs, which were covered by the insurance, because they worried they could not afford to pay out-of-pocket for contraception down the line.” 

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