Q & A with Dr. Paola: Can I get an overview on birth control options?

By Dr. Paola Bordoni, OBGYN & MOONS Medical Advisor
Through history, birth control has been a controversial subject. In the modern era, it was criticized, then hidden, then applauded and then became mainstream. Modern medicine has gifted us an arsenal of options. We have: implants, injections, vaginal rings, patches, pills, condoms, diaphragms etc. Each option may carry benefits or risks, but the variety allows an option for most everyone. Lets discuss those options:

Condoms: The condom is the most easily available and straightforward. Even Egyptians used animal bladders as condoms centuries ago. The rules are simple: Use the correct size, apply before penetration, remove after use, verify it is intact after removal, discard. The condom confers safety from many STDs and carries a low risk of pregnancy if used properly.
The Pill: The birth control pill has evolved immensely since its initial FDA approval in 1960. The initially marketed pill had over 5 times the estrogen of today’s pills! Today's pills have come a very long way from their precursors. For this reason, learning the true side effects of the specific option you choose is important!
Birth control pills are either Estrogen / Progesterone pills or Progesterone-only pill. The cocp’s (combined ocps) have traditionally been more efficacious than pocps, but there is now a pocp whose efficacy reaches that of the cocps. Side effects depend on the combination of hormones (not all progesterones or estrogens are the same) and dosage of the hormones. As you can imagine, the combinations are endless. For this reason, not all pills have the same side effects and your doctor can oftentimes find a fit for you. Some pills may cause water retention, while some actually do the opposite. Some cause hunger and slight weight gain while others may decrease appetite or cause nausea.
Birth control pills give low risk of pregnancy (less than 1%), but this may change drastically if not used correctly. The pill must be taken daily and at the same time each day. The last few days of the pack (usually the last 3-7 depending on the pack) will be either lower hormone or placebo pills. During the last week of pills is usually when one will menstruate. Some pills will be very low dose and may cause you to stop menstruating eventually. Lack of menses is medically acceptable and is not a cause for concern. Taking a pill late or missing a pill may cause ovulation and pregnancy; therefore, those who are not good at daily dosing are not good candidates for the pill.
Some individuals aren't good at taking birth control pills but appreciate some of the benefits of hormonals (clear skin, regular menses, light cycles). These people may be recommended the patch or ring. Both these options confer approximately the same efficacy as the birth control pill. Side effects of the ring or patch are similar to birth control pills because they are combined estrogen/progesterone methods.
The Patch: The patch is a sticker that is applied to the skin for one week at a time for three weeks followed by one week of no patch. Menstruation usually occurs during the ‘patch-free’ week.
The Ring: The ring is a plastic circular ring that is folded in half and placed into the vagina by the patient. It is used for three weeks and then removed for one week. Menstruation will usually occur during the ‘ring-free’ week. This method has both a disposable ring (used 3wk) or a non-disposable version (used one year) to decrease our carbon footprint. The ring may be left in during intercourse or removed for up to three hours during intercourse.
There are then some forms of birth control that are less "user dependent." Consider the college student pulling all nighter study sessions or the waiter working weird hours or the new mom with a crazy sleep schedule. These individuals may not be good at taking a pill daily or changing a ring weekly. For these individuals, there are longer acting birth control methods.
The Injection: The first option that is not as "user dependent" is the progesterone-only injection. This is usually administered every three months. It is considered more efficacious than the previously mentioned options but mostly due to being less user-dependent. The injection has a high rate of amenorrhea (lack of menses) which may/not be appreciated by the user. Its side effects are irregular menstruation (overall less volume usually), bloating, acne, hair loss, weight gain.
LARCs (IUDs & Implants): The least "user-dependent" option is grouped into a category of its own! These methods are called Long-acting Reversible Contraception (LARCs) and are the most recommended in young adults today.
LARC’s include the IUDs and the arm implants. IUDs are placed into the uterus by a doctor and can be removed immediately or up to 5-10y later. Contrary to common belief, you do not have to have had children to be a candidate for an IUD. Risks of migration and expulsion are approx 1%, while risk of pregnancy is less than 1%.
There are two types of IUDs: hormonal and non-hormonal. The hormonal versions only contain progesterone. Progesterone IUDs will cause less to no menses although bleeding patterns may be unpredictable. Side effects are minimal but include bloating, weight gain, hair loss and acne. The only non-hormonal IUD is the Copper IUD. This IUD will usually cause regular menstrual cycle intervals but oftentimes with a slightly heavier flow. Side effects are minimal due to lack of hormones.
The arm implant is a favored method for young adults. It's an implant placed into the arm by the doctor through a needle. Placement takes a couple of minutes. This implant confers the lowest risk of pregnancy! The side effects are similar to the progesterone IUD, including the irregular yet lighter menses.
In conclusion, there are a plethora of wonderful birth control options. This quick review serves to give an intro to the more commonly used birth control methods. If you need birth control, see your doctor and they can find a good fit for you!
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