Birth Control in 2015: Making the Right Choice

With permission from Brenda Washington

Most women in the Rochester area (and United States for that matter!) will end up having 2 children but will spend most of their reproductive lives—about 35 years—trying to avoid an unintended pregnancy. Unfortunately, about half of all pregnancies today are unintended and affect mostly younger women—teenagers and twenty-somethings.

For some women, it seems like there’s no “perfect” contraceptive yet there have never been as many high quality methods available as there are today.  This series of articles will review today’s available methods and may provide some insight about how you can make a good choice for yourself.  We will also share not just the science, but our personal experience in proving these methods of birth control (contraception) over the past few decades.

Spontaneous versus non-spontaneous methods

One way to think about contraception is whether or not any pre-planning is necessary.  Older methods such as condoms and diaphragms offer protection but unfortunately there are many failures for one simple reason–in the “heat of the moment” it’s easy “forget” to use them.  When used “perfectly” they offer excellent results—but mistakes are all too common.

Spontaneous contraception—the methods you don’t have to think about in the midst of sexual activity– offer the advantage of not having to take a “time-out” during sexual foreplay.  Spontaneous methods of contraception include “hormonal”, “mechanical” and ones that are both “hormonal & mechanical.”

In general—as with most medical “solutions” we try to start with simple and safe approaches.  But let’s consider each of these 3 separate categories.  In this segment we’ll begin with a discussion of hormonal contraception.

Birth Control Hormones

Hormone use for birth control (hormonal contraception) can be divided into 6 categories!  Truthfully, we have an unbelievable number of choices today.

1.     Oral contraceptive pills (OCPs)Birth control pills or OCPs have been around in the U.S. since 1960. OCPs typically contain a combination of hormones—an estrogen and a progestin.  They contain far smaller amounts of these hormones than when they were first introduced.

There are pills that provide women with light periods once a month and even “extended cycle pills” that will only cause you to menstruate only every 3 months. Examples of the extended cycle pills include Seasonale and Seasonique.

Birth control pills are exceptionally safe for most women—but not perfectly safe.  Women who smoke or have hypertension, diabetes or other risk factors for heart disease and strokes should probably avoid combination birth control pills.  Likewise, women who have a blood clotting disorder such as Factor V Leiden thrombophilia along with women with breast cancer or uterine cancer are not candidates for OCPs.

There are also many health benefits for women who use OCPs.  Women often find that OCPs cause lighter and less painful menstruation.  In other instances OCPs are used to “regulate” abnormal menstruation and reduce the occurrence of painful ovarian cysts.  Some women notice that OCPs reduces acne and improves their overall complexion.

The use of OCPs has actually been linked to a reduced likelihood of ovarian and uterine (endometrial) cancer.   Learn more about birth control pills…

The “mini-pill” or the progestin-only (norethindrone) contraceptive pill. Some of the available brands include Nor-Q.D®, Micronor®, Camila®, Jolivette®.  Unlike OCPs which contain varying amount of estrogens and progestin the “mini-pill” contains only a progestin—specifically norethindrone.  The mini-pill works by causing the endometrium (lining of the uterus) to get “thin” and for the cervical mucous to “thicken.”  These 2 actions prevent sperm from reaching the egg. These pills need to be taken every day at the same time to be effective.  The mini-pill can be used under circumstances when OCPs, birth control rings and birth control patches should not be used—such as diabetes, hypertension or a history of smoking.

Because the mini-pill isn’t quite as effective as the OCPs we tend to discourage its use for younger women (under the age of 30).

The side effects of the mini-pill can be annoying but not dangerous.  You should discuss these with your health care provider.  Some of the side-effects include irregular menstrual bleeding, acne, breast tenderness, depression, fatigue or some loss of sex drive.

As with any pill, you can try it and see how it works for you.  If you experience any of these troublesome side effects, you can call a “time out” and move on to something else.

2.     Vaginal Ring (NuvaRing ®)–Many women find it very inconvenient to remember to take a pill at the same time of day each and every day. The NuvaRing delivers a combination of estrogen and progestin much the way oral contraceptives do–the difference is in the way the medications are delivered.  Instead of taking a pill each day a hormone-containing ring is inserted into the vagina and is left in place for 3 weeks at a time.  During this time it slowly releases estrogen and progestin into the body and works much the same way as contraceptive pills.  The ring is left in place during intercourse — typically neither partner can feel it.

When the ring is removed—after 3 weeks—you will generally experience a light period during you “ring-free week.”  The ring has the same risks and benefits as oral contraceptives.

3.     Birth Control Patches (Ortho Evra)—The “patch” was introduced in 2002 and is another example of an effective estrogen and progestin combination with risks and benefits nearly identical to birth control pills.  What’s different about the patch is that, like the vaginal ring, it’s the delivery system.   Typically a woman starts “the patch” on the first day of her menstrual cycle—but this can be varied.  Whatever day she chooses becomes the “patch change day”.  The patches are packaged inn boxes of 3 and a woman uses one patch per week.  After 3 weeks of “patch protection” no patch is applied on the 4th week and the woman experienced a light menstrual period.  Some women use an “extended use regimen” where they go directly from one box of patches, but do not take a week off and instead immediately start a new box of patches.  This allows a woman to control the number of periods she gets per year.

As already noted, the advantages and disadvantages of contraceptive patches are nearly identical to birth control pills.  Some studies, however, suggest that contraceptive patches may be associated with a higher level of blood clots (thrombosis) than with birth control pills.  Some women do get a skin reaction at the site of the patch while in other women the patches don’t adhere well to the skin and may fall off prematurely.

It’s also important to note that contraceptive patches may be less effective in women weight less than 198 pounds (90 kg).

4.     Injectable contraceptives (Depo-Provera)—Depo-Provera (medroxyprogesterone) has some resemblance to the hormone progesterone.  It’s an injection that can be given in the arms, buttocks or thigh and is generally administered every 12 weeks.  It has an excellent safety record and has been in use since 1967.

The benefits include the fact that it is highly effective at preventing pregnancy, contains no estrogen and does not increase the risk of thrombosis, pulmonary embolism and strokes or heart attacks.  It can be used to decrease the likelihood of uterine cancer in women who are at risk. Depo-Provera also offers relief from endometriosis-induced pain and other causes of severe cramps related to menstruation.  Another “advantage” is that most women using Depo-Provera will not experience periods.  Other women, however, find this to be an undesirable side-effect.

The major annoying side effects of Depo-Provera include weight gain, irregular vaginal bleeding, bloatedness and depression.  Rarely some women report hair loss.

5.     Implantable Rods (Implanon and Nexplanon)—These contraceptive implants—about the size of a small matchstick–were first approved for use in the U.S. in 2006 and are part of a group of contraceptives known as long-acting reversible contraceptives (LARCs).   Implanon and Nexplanon each contain 68 mg of the progestin etonogestrel).  The implants are highly effective in preventing pregnancy for up to 3 years. The benefits and side effects are similar to those described with Depo-Provera.  Unlike Depo-Provera which is injected every 3 months Implanon and Implanon or Nexplanon must be inserted—generally on the inside of the upper arm—between the biceps and the triceps.  Some bruising after insertion is quite common.

Unwanted side effects from Implanon/Nexplanon include weight gain, bloatedness, depression, acne, irregular menstrual bleeding and headaches.