Whether you are a teenager with no plans for pregnancy anytime soon, a twenty-something with one child and the desire to “take a break”, or a woman in her 40’s with two or three kids who doesn’t want any more, Birth Control is something that almost every premenopausal woman (and most men) have thought about at some point in their lives. For better or worse, our society prides itself on the availability of “options”. In most cases, having a choice is a good thing. But when it comes to birth control, that choice can be overwhelming – hormonal vs. non-hormonal, reversible vs. permanent, daily, weekly, monthly, quarterly, long-term – the decisions that need to be made can be confusing. Couple that with a distinct shift in healthcare from “Physician-mandated” to “Patient-directed” decision making (as I discussed in an earlier post), and my role becomes that of advisor – the patient is the “CEO” and must make the final decision.
With that in mind, I am going to attempt to break down currently available birth control options, using 3 questions that I think women might find helpful to make that decision. Thinking about these questions before your visit will help streamline your doctor’s efforts to help you decide what to do.
Question 1: Permanent or Reversible?
This should be one of the simplest questions to answer, yet some struggle with it. The answer will depend on several factors: your age, how many children you have, how many children you want, your state of health, and a few others. But, this should always be one of the first questions you answer for yourself.
Permanent birth control has been discussed in a prior post. But to make it simple, this means “blocking the tubes – male or female”. Several methods exist for doing this – all are outpatient procedures, and most don’t even require general anesthesia.
If you are not ready for permanent, irreversible birth control, proceed to question number 2:
Question 2: Hormones or Non-hormonal?
A few factors come into play in making this decision. Hormones are medications, and just like any other medication, they have potential side effects and risks. To avoid these risks completely, choose non-hormonal. Non-hormonal birth control methods include:
Natural family planning – includes abstinence (the single most effective birth control method there is), the rhythm method (which can be very effective if used correctly), and withdrawal (aka “pulling out” – which almost NEVER works)
Barrier Methods – such as condoms or diaphragms
Intrauterine device – these can be placed in the uterus by your doctor, and work for up to 10 years. A great method if you want to have birth control you don’t need to think about!
Question 3: How often do you want to have to think about birth control?
Daily – The oldest and most commonly used method of hormonal birth control is the oral contraceptive pill (or just “the pill”, for short).
Weekly – The contraceptive patch is worn on the skin and is changed weekly. A better option than pills if your typical day is hectic.
Monthly – The vaginal ring is placed vaginally (hence the name) at the beginning of the cycle, left in for 3 weeks, and taken out for one week. Then, the cycle is repeated.
Quarterly – The birth control “shot” is given every 3 months, and is usually done by your doctor’s office. A helpful side effect, for many, is that menstrual cycles usually stop while you are on the medication. The disadvantage: multiple potential side effects, including irregular bleeding (especially at first), weight gain (in about 10% of women), and exacerbation of depression.
And if you don’t want to think about it at all (i.e., let the doctor worry about when to “update”):
3 years – An implantable device can be inserted in the upper arm which releases hormones over a 3 year period. Side effects are similar to the birth control shot mentioned above, with the distinct disadvantage of needing a minor surgical procedure to place and remove the device.
5 years – A hormone-containing Intrauterine Device (IUD) can be placed in the uterus and will last 5 years. The advantages here are minimal side effects, no need to remember to do anything for 5 years, and complete reversibility (if you change your mind before 5 years, we just take it out). This method will also do a phenomenal job of decreasing menstrual flow – so it is a great option if you have heavy periods and need birth control.
This post is not meant to be an exhaustive review of birth control options. It is meant to help “jump start” the process of deciding what method of birth control is right for you. There are many advantages and disadvantages of birth control that have not been discussed here. And there may be aspects of your overall health which make one option better than another.
This brings me to my Disclaimer: This is not how everybody will go through the decision-making process, and these questions do not necessarily need to be answered in this order. Furthermore, this should not substitute for a thorough discussion with your physician. An appropriate decision can only be made once you have considered all your options, and discussed them with your doctor.