Take the lead – Find the best birth control for you

There are a dizzying array of contraceptive products on the market today from rings and implants to pills and patches. The sheer number of choices can make it challenging for women to choose.

But Danielle Roncari, MD, Director of Family Planning at Tufts Medical Center in Boston says the decision about birth control doesn’t have to be complicated if you understand your options. Below is a rundown of some of the most common categories of contraceptives, and the advantages and disadvantages of using them.

The LARCs

The most effective type of reversible contraceptives are called Long Acting Reversible Contraceptives or LARCs. This category includes two different options, the intrauterine device (IUD) and the birth control implant.

An IUD is a small T-shaped device that your doctor inserts into your uterus, where it remains until he or she removes it. There are two different types of IUDs, the copper IUD, which does  n’t contain hormones and protects against pregnancy for up to a decade, and an IUD that releases a hormone called progestin and protects you for three to five years, depending on the device.

A birth control implant, on the other hand, is a small rod, described by the American Congress of Obstetricians and Gynecologists (ACOG) as the size of a match stick. Your doctor also inserts this device, but this time under the skin in your arm to protect you against pregnancy for up to three years.

“Perhaps the biggest advantage of these types of birth control is that they are highly effective,” said Roncari. “According to the ACOG less than 1 in every 100 women will get pregnant using these devices in the first year. These devices are 20 times more effective than other hormonal birth control methods,” said Roncari. “Primarily because they’re inserted by your doctor, which means there’s no room for user error, like the whoops of forgetting a pill.”

If you do decide you do want to get pregnant, your doctor can easily remove the device.

It used to be that doctors only recommended IUD’s to older women who had already had children, but today research shows they’re a good option for young women as well. “They should be the first line in preventing pregnancy,” said Roncari.

“But while these are the most effective methods, they’re not the most popular, likely due to the need for it to be inserted and removed by a doctor, which even though it’s a simple process, might steer some women away,” said Roncari.

Hormonal Methods

The second major category of birth control methods includes hormonal methods. These include the birth control pill, the vaginal ring, the contraceptive skin patch and the contraceptive shot. The pill, ring and patch all prevent pregnancy by introducing a combination of two hormones into your system, progestin and estrogen. There is also a progestin only pill and the contraceptive shot is a progestin only method.

The birth control pill is a monthly supply of medication that you take every day to prevent pregnancy. The vaginal ring is a plastic device that you place inside your vagina once a month, where it secrets hormones. The skin patch is a little patch you wear on your skin and change once a week. Your skin absorbs the hormones from the patch to prevent pregnancy.

These birth control methods have a higher failure rate than the LARC methods, largely because women sometimes don’t use them properly. With what the ACOG calls “typical use,” 9 in 100 women will get pregnant using these methods each year. If used perfectly, less than 1 out of 100 would.

“These hormonal methods may have advantages for some women, because they not only prevent pregnancy but can help give women a predictable, often lighter, menstrual cycle, can treat a certain type of pelvic pain, may decrease a woman’s risk of ovarian cancer and uterine cancer, and are sometimes used to treat acne,” says Roncari.

The contraceptive shot is also a highly effective method that requires visiting your health care provider every three months for a shot. With “typical use,” 3 in 100 women would get pregnant using this method each year. Perfect use would result in less than 1 out of 100 women getting pregnant.

Hormonal methods can be very effective, but if you’re the type of person who is scattered or forgetful they might not be your best option.

Making Your Decision

“The best way to decide which type of birth control is right for you is to sit down and have a conversation about your options with your doctor. Women may also want to ask their friends about their birth control methods and whether they recommend them, but always be sure you’re getting your information from a reliable source,” said Roncari.

“When considering your options your top priority should be effectiveness and safety,” said Roncari. Some birth control methods may not be appropriate if you have certain health conditions. For example, women with certain types of uterine anomalies might not be good candidates for an IUD. Similarly if you have a personal history of blood clots, the estrogen-containing birth control pill probably shouldn’t be your top choice. Your doctor can explain all the potential risks of each individual method.

Roncari also notes that while condoms aren’t the most effective choice for preventing pregnancy, they are highly effective at preventing transmission of sexually transmitted diseases, so it’s wise to use them along with other birth control methods.

“The key to making the best contraceptive decision is to make sure you have accurate information to guide your choice,” she said. The birth control options outlined above aren’t the only choices available. Your doctor may be able to give you additional options as well. And if your birth control method fails, emergency contraception is also available through your doctor that can help you prevent a pregnancy.

Exploring all the different choices available to you can help you select the birth control method that is not only effective, but is also comfortable and fits into your lifestyle.

To make an appointment to talk to a Family Planning specialist in Boston about the right birth control method for you, please call 617-636-1379 or visit www.tuftsmedicalcenter.org/familyplanning.