Last month we began our birth control series, providing you with different methods available to you. This month’s is the second and last part of the topic; we hope you resolve to take control of such health decisions by equipping yourself with adequate knowledge. We’ll continue to review the various types of birth control as well as their pros and cons.
The patch (Ortho-vera)
This is a small, 4½-centimeter, square plastic patch placed on the skin of either the stomach, buttocks, upper arm or upper torso (excluding the breast). One patch is placed once a week—preferably the same day of the week– for three continuous weeks. The old patch is removed before a new one is placed preferably in a different spot. No patch is used on the 4th week during which time menstrual-like bleeding will occur. The patch works just like the combination birth control pills because it contains both estrogen and progestin.
These hormones go through the skin, into the bloodstream and prevent ovulation from occurring. It also causes the cervical mucus to thicken, which prevents sperm from getting into the woman’s uterus. The appeal of the patch to many women is that you only have to remember once a week to wear it as compared to the pill which you have to take everyday.
Advantages:
The patch is a convenient, simple and easily reversible form of contraception. As mentioned earlier, since it contains the same hormones as the combination pill, it has the same health benefits such as less risk of ovarian cysts, breast tumors, ovarian and endometrial cancers. Women have more regular periods, less menstrual cramps or pains, less acne and less body hair (hirsutism).
Some data show that the patch offers some protection from ectopic pregnancies (pregnancy in which the baby grows somewhere else in the body instead of the womb. This can lead to excessive bleeding and death of both baby and mother), osteoporosis (loss of bone mass), vaginal dryness which may cause painful intercourse during menopause and infection of the fallopian tubes (tubes that connect the ovaries to the uterus; infection of the tubes significantly increases one’s risk for ectopic pregnancies). Some women like the patch because it does not interfere with their experience of sex as the condom does. Also, you can participate in normal activities such as swimming, exercising or taking a shower while wearing the patch.
Disadvantages:
Unplanned pregnancies can occur while using the patch if it falls off or becomes loose for more than 24hours or if the same patch is used for more than 1 week. The patch offers no protection against STIs so it should be used with a condom. Women who weigh more than 198 pounds should not use the patch as studies have shown it to be less effective. If you also use any of the following medicines or herbs, please talk to your health care provider before starting the patch because they might affect its ability to work properly: Rifampin, anti-fungals for yeast infection, anti-HIV protease inhibitors, St John’s wort, and some medicines to treat seizures, mental illness or headaches.
Side effects some women have on the patch are also similar to those with the birth control pill, such as irregular bleeding or spotting, nausea, weight gain, breast tenderness, mood changes and high risk of blood clots in women who smoke. Other women complain of skin reactions such as rashes, redness or itching at the site of application of the patch. Some women who wear contact lenses might experience a change in vision which should be reported immediately to a doctor.
The Ring (NuvaRing)
This is a small flexible ring that is inserted into the vagina once a month, left in place for three weeks and then removed for the last week. Just like the combination birth control pills and patch, it works by releasing estrogen and progestin which prevent pregnancy. Menstrual-like bleeding usually occurs two to three days after the ring is removed and might continue up to the time a new ring is placed. To ensure effectiveness, the new ring should be placed exactly one week after the old one is removed even if a woman is still bleeding.
Advantages:
Most of its benefits are similar to that of the patch as described above. It is simple, convenient, and easy to insert and remove.
Disadvantages:
Shares most of the disadvantages associated with the patch including interactions with other medicines. Unplanned pregnancy can occur if the ring expires, the package is exposed to very high temperatures or direct sunlight or if the ring slips out of the vagina and is not replaced within three hours. Women who are uncomfortable touching their private parts might have problems using the ring because it requires insertion into the vagina.
It is advised that the ring should not be used by women with any of the following conditions: clotting disorder, strokes or mini-strokes, heart disease, severe high blood pressure, diabetes, severe headaches, breast cancer, endometrial cancer or any other estrogen-dependent cancer, unexplained vaginal bleeding, liver disease or liver tumors, jaundice during pregnancy or from prior hormonal contraceptive use, pregnancy, allergy to any component of NuvaRing.
The “Shot” (Depo-Provera or DMPA)
This is a progestin-only contraceptive given through injection. One shot can prevent pregnancy for up to 12 weeks. As such, it is very convenient and used by women who do not want to worry daily about birth control or who want a more private method of birth control. Like the progestin only pill (POP), it works by preventing ovulation mainly.
Advantages:
Like POP, it can be used by women who cannot take estrogen for various health reasons and those breastfeeding. The shot has also been shown to reduce risk for endometrial cancers. It is ideal for women who feel uncomfortable inserting other methods into their vaginas.
Disadvantages:
Need to get a shot every 3 months at a health center. Difficult to reverse effect compared to other forms of birth control – it can take as much as a year before one can get pregnant after stopping use. Very rarely, unplanned pregnancies can occur while using the shot. When this does happen, usually it is an ectopic pregnancy which increases risk of excessive bleeding or death of baby or mother if not detected early.
A very common side effect is irregular bleeding or spotting during the first year of starting the shot. Some women experience changes in menstrual flow which either becomes longer and heavier or fewer and lighter. Because it contains only progestin, the shot does not protect against bone loss but might rather contribute to it. Other less common side effects include hair loss, nausea, depression, weight gain, breast tenderness and decreased sex drive. If any of these should occur while using the shot, report to your doctor immediately. Women with breast cancer, those taking medicines for Cushing’s syndrome or who plan to get pregnant within the next year, should not use the shot as a form of birth control.
The Implant (Implanon®)
This is a soft, small, flexible plastic inserted just beneath the skin of the upper arm. It contains progestin which prevents ovulation and also thickens the cervical mucous. Insertion and removal take only a few minutes but the implant is effective up to 3 years after it is placed.
Advantages
Small, easily reversible, convenient and a very private method of birth control. It can be used by women who are breastfeeding and those who cannot take estrogen.
Disadvantages
The implant offers no protection against STIs and as such should be used with a condom. It is not suitable for women who are overweight or are taking certain medicines such as rifampin, St John’s wort or those for the treatment of seizures, HIV or yeast infection. Women who might be pregnant or have breast cancer should not use the implant. Like other progestin-only contraceptives, the most common side effect is irregular bleeding or changes in your normal menstrual flow. One out of three women might have no periods after use of the implant for a year. Other women experience mood swings, weight gain, headache, nausea, acne, depression, decreased sex drive, breast tenderness and some pain at the insertion site.
The Diaphragm
This is a soft, dome-shaped rubber disk with a flexible rim inserted into the vagina. When inserted properly it should cover the cervix and work by preventing sperm from entering the uterus. It is recommended to use it with a spermicide which will kill sperms that enter the vagina. Once a diaphragm is inserted, it can be left in place up to 24 hours. However, spermicide should be added every two hours or each time sexual intercourse occurs to ensure maximum effectiveness. It should only be removed six hours after sexual intercourse as some sperm might still be in the vagina.
Advantages:
Ideal for women who have sexual intercourse occasionally and want a simple, convenient and easy-to-use device. It is also easily reversible, and not felt by the woman or partner when inserted well. It does not interrupt sex play because it can be inserted hours earlier. Can be used by women who are breast feeding.
Disadvantages:
Women who are uncomfortable touching their genitalia may not like the diaphragm. The first insertion, to determine the right size to fit your cervix, needs to be done by a doctor. A new fitting might be necessary after having a baby, miscarriage, pelvic surgery or significant weight gain. If the diaphragm is left in the vagina for more than 24 hours, it might cause toxic shock syndrome (TSS—a life-threatening bacterial infection).
It should not be used by women who have recurrent urinary tract infections because the diaphragm does increase risk of bladder infections in some women. To help decrease bladder infection, try to urinate before inserting the diaphragm and after sexual intercourse. Also, it cannot be used during menstruation. The diaphragm might be pushed out of place by some sexual positions, penis sizes, and thrusting techniques or angles, thereby rendering it less effective. Side effects common with the diaphragm include irregular bleeding, burning on urination, itching around the genitalia and occasional vaginal discharge.
Intrauterine Devices (IUD)
An IUD is a small T-shaped plastic device with a string attached at one end of it. It is inserted inside the uterus by a doctor and can be removed only by your doctor. It prevents pregnancy by first preventing sperm from getting near an egg to fertilize it. If fertilization should occur, the IUD changes the lining of the uterus, which makes it hard for a fertilized egg to implant and grow in the womb. It is an ideal means of birth control for women who want a longer lasting method. It is now the most popular form of reversible birth control in the world.
Types:
ParaGard (Copper T 380A): This is made of copper and can be left in the uterus for up to 12 years.
Mirena: This is a plastic IUD that also releases progestin. As such, it is more effective than the Cooper IUD since it also works by preventing ovulation and thickening cervical mucous. The Mirena can be left in the uterus for five years.
Advantages:
Generally, IUDs offer a very convenient and private form of birth control. Some women say that compared to other forms of contraceptives, they find that the IUD improves their sex life as it does not interrupt sex play, is not messy and cannot be felt by either the woman or her partner. Because the Mirena contains progestin, it offers similar benefits as the progestin-only pill.
Disadvantages:
Like other forms of contraceptives, women might have irregular bleeding and spotting with the IUD. Rarely, perforation of the uterus might occur while the IUD is being inserted which can lead to excessive bleeding, infections and might require surgery to correct in extreme situations. Occasionally, the IUD will partially slip out of the uterus which makes it less effective. If detected, it should be reported immediately to your doctor. If one should get pregnant with an IUD in place, there is an increased risk for ectopic pregnancy, miscarriages or early labor and delivery.
Tubal Sterilization (Bilateral Tubal Ligation- BTL)
This is a surgical procedure that involves tying or cutting a woman’s fallopian tubes. This prevents eggs from getting into the uterus or sperm from getting to where the eggs are. As such, it is a very effective, permanent form of birth control ideal for women who have either given birth to all the children they want or who do not want to have children at all. Since the procedure is considered permanent, it should be thought through completely by both partners and discussed with a health care provider before choosing it.
Women should not feel pressured to have a BTL especially if they are open to having children in the far future. Other reasons to have a BTL include health problems that prevent a woman from getting pregnant or going through labor. Families who are also concerned about passing on a hereditary disease or disability to offspring might consider having a BTL but again only after series of discussions with their doctor.
For more information on this surgical process, visit here.
Advantages:
It offers a permanent form of birth control that requires no worrying over the possibility of getting pregnant or having to remember to take daily. Women find their sex play more enjoyable since it does not interfere with intercourse, is not messy or embarrassing to use compared to other contraceptives. It does not affect sexual drive and might improve sex play for some women due to less stress over unplanned pregnancies.
Disadvantages:
Like any other surgical procedure, risks include infection, bleeding and side effects of the anesthesia used. Rarely perforation of the uterus or other organs close by might occur. BTLs offer no protection against STIs and as such, condoms should be used during sexual intercourse. Women continue to have normal menstrual cycle after having a BTL which some find frustrating. Since it is considered a permanent form of contraceptive, it is extremely difficult to reverse in the future if a woman changes her mind. As such, it is not advisable in women younger than 30.
Vasectomy
This is a permanent birth control method for men. It involves a simple surgical procedure in which the tubes (called vas deferens) through which sperm travel from the testes to the penis, are tied or cut. As such, when a man ejaculates during sexual intercourse, there is no sperm in the fluid which comes out of the penis and he cannot impregnate the female. However, the appearance of the fluid and the quantity will still be the same because the very tiny sperm occupy only a small fraction of the ejaculate. Of note, a vasectomy does not affect a man’s ability to have an erection, get hard or have normal sexual drive.
Advantages:
Allows men to be involved in birth control decisions and offers a permanent, convenient form of contraceptive.
Disadvantages:
Not effective immediately since sperm remain in the tubes up to 3 months after the procedure is done. As such, there is a possibility of getting a woman pregnant if sexual intercourse occurs soon after. A semen analysis test can be done by your doctor to determine when there are no more sperm in your ejaculate. Rarely, tubes that have been cut can grow back together again resulting in unplanned pregnancy.
This concludes our review of the various birth control options available. The table below compares the failure rates of each of the contraceptive methods discussed in both parts of this series. As always, all medical decisions should be made after careful review of data and discussion with your healthcare provider.
Failure rates for birth control methods when used correctly
| (Number of pregnancies in 100 women per year) | |
| Male condom alone | 11 |
| Female condom alone | 21 |
| Diaphragm with spermicide | 17 |
| Cervical cap with spermicide | 17 to 23 |
| Sponge with spermicide | 14 to 28 |
| Spermicide alone | 20 to 50 |
| Oral contraceptives | 1 to 2 |
| Contraceptive patch* | 1 to 2 |
| Vaginal contraceptive ring | 1 to 2 |
| Hormone shots | less than 1 |
| IUD | less than 1 |
| Periodic abstinence | 20 |
| Tubal Ligation | less than 1 |
| Vasectomy | less than 1 |
| Contraceptive patch is less effective in women weighing more than 198 pounds. | |
| Information from U.S. Food and Drug Administration. Birth Control Guide. Retrieved by familydoctor.org on August 4, 2004, from the World Wide Web: http://www.fda.gov/fdac/features/1997/babytabl.html |