Know your contraceptive options to decide which one is best for you

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The subject of birth control continues to grab the headlines, as the recent news in France offering free birth control to all women up to age 25 from next year. Yet the different forms of birth control remain a confusing topic for many women.

Contraception is still commonly used in the United States, with 64.9% of the 72.2 million women ages 15 to 49 using some form of contraception, according to the CDC. It’s easy to get confused with the many contraceptive options available and which one is best, but it’s important that everyone understands the different common types and determines which one is best for each person.

IUD

Intrauterine devices (IUDs) are currently the most durable reversible forms of contraception. An IUD is a small “T” shaped device that a provider places inside the uterus to prevent pregnancy. They can be doubled with or without hormones.

For example, the two main types of IUDs are the copper IUD (without hormones) and the levonorgestrel IUD, which releases a small amount of a hormone called progestin each day to prevent pregnancy. These devices can provide years of protection; the copper IUD can last up to 10 years and the levonorgestrel IUD can last up to 3 to 6 years.

According to the CDC, IUDs have some of the lowest pregnancy failure rates compared to other forms of reversible contraceptives and are removed by a provider if they are no longer wanted or to be replaced. Unlike the TikTok trend that women remove their own IUDs, removing an IUD without a healthcare professional in a healthcare facility is not recommended.

Birth control pills

Birth control pills are an easy type of birth control to use, but medical history should be taken into account. Oral contraceptives, or birth control pills, are prescribed by a provider and must be taken daily to get their full effect. The type of pill that is best to use depends on the person’s medical history.

For example, the combined estrogen plus progestin pill may not be recommended for someone with a history of smoking, blood clots, or breast cancer. However, the progestin-only pill may be a good option for women who cannot take estrogen. Overall, it is necessary to discuss this with a provider to determine which pill form is best for you.

Hormonal contraceptives

Hormonal contraceptives can take many forms, including implants, injections, and patches. Using either the hormone progestin or a combination of progestin and estrogen, these forms of birth control are given as an injection, a patch on the skin, a ring in the vagina, or an implant in the arm.

The implant is a very small flexible plastic rod that is placed under the skin of the upper arm by a doctor and can last for about three years during which the provider can remove or replace if the patient wishes. Injections, like the Depo-Provera bite, are given every three months. The patch and ring are used for three weeks and removed in the fourth week to allow menstruation, a period similar to that of the pill.

Of these hormonal options, arm implants have the lowest failure rate, according to the CDC, but all are effective in reducing the risk of pregnancy.

Barrier methods

Some barrier methods offer protection that can help reduce the risk of sexually transmitted infections (STIs). Methods such as male and female condoms are the only types of birth control that can help prevent STIs.

STIs such as chlamydia and gonorrhea are at an all time high for the sixth year in a row, making these barrier methods invaluable to use in combination with other forms of contraception. It is important to note that a diaphragm or cervical cap, two types of barrier methods, do not prevent STIs.

As we know, barrier methods are not foolproof and always carry a risk of getting an STI or getting pregnant. However, it is recommended to use condoms in addition to other forms of birth control to effectively protect against STIs.

“Bind the tubes” and vasectomy

“Ligation tubes” and vasectomy are permanent forms of birth control. The most common contraceptive method used by women in the United States was female sterilization, or “tube ligation,” at nearly 19%. This procedure is performed by a doctor in a hospital or outpatient surgery center. The method is effective immediately and women can then resume their normal activities within a few days.

The same is true for a vasectomy in men. After the operation, the man follows up with a provider to test his sperm count and make sure it has dropped to zero, which may take a few months. Both are safe routine procedures which also have very high success rates in preventing pregnancy.

Weigh the options

With a plethora of contraceptive options, the key is to discuss the ideal options with a provider to determine which is the most convenient and safest for you. Medical history and preferences are all important factors in determining which option is best for you.

Alexis E. Carrington MD will be a resident of dermatology in the Department of Dermatology at George Washington University. She completed her preliminary year of internal medicine at the Mount Sinai Icahn School of Medicine Elmhurst Hospital Program in New York City at the start of the COVID-19 pandemic. She is interested in Ethnic and Medical Dermatology, Underserved Dermatology and Global Health and Dermatologic Surgery.



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