Last week’s article brought us to the year 1965 in the history of birth control. This week we offer a list of contraceptives that are currently available to women in the United States. There is a wide variety of options from which to choose, based on lifestyle and budget
These are among the most popular because of their reliability and ease of use. They all work similarly and can be obtained and managed by women without any help from their partners. None of these methods prevents sexually transmitted diseases, but some of them can interact with medications or supplements, so be sure to tell your physician about any prescriptions or over-the-counter products you are taking. These methods are available by prescription only, but some (or all) expenses may be covered by health insurance benefits. These methods work primarily by preventing ovulation through the use of hormone replacement. If ovulation has already occurred, however, the drug’s next stop-gap prevents sperm from fertilizing the egg. If both of these measures fail, then the uterus’ lining (which has presumably thinned from taking the hormones) will likely not support the implantation of a fertilized egg and expel it. Interestingly, what most of us consider as the “period,” that occurs on the break week is actually a withdrawal bleed that is caused by the body’s withdrawal from the synthetic hormones that are used in these products. Missing doses is the main reason that hormonal methods fail and result in pregnancy. Fortunately there are smartphone apps that can help keep you on schedule!
Pills, Patches and Rings
These systems deliver medicine via pills, dermal patches or “rings” which are inserted into the vagina. They require some vigilance on the part of the patient, because they must be taken (or changed) on a daily, weekly or monthly basis (depending on the method) to achieve maximum effectiveness. They contain estrogen, progesterone, or both, and mimic the natural hormones in a woman’s body to prevent ovulation. Also, the lining of the uterus becomes thinner, which makes implantation difficult and cervical mucus becomes thicker, which prevents sperm from entering it. Advantages include predictable menstrual cycles, less acne, some protection against non-cancerous breast tumors and ovarian cysts, and decreased risk of ovarian and uterine cancer. Risks include a small increase of deep vein thrombosis (DVT), heart attack, stroke, nausea, breast tenderness, break-through bleeding and high blood pressure. Smoking cigarettes can increase these risk factors. These methods are 99% effective with perfect use, but 8% will accidentally get pregnant during the first year of use – mostly because of user errors.
Depo Provera is a shot that requires a prescription and is given by a health care professional every twelve weeks. It works the same as other hormone-based methods except that it uses only progesterone. When used perfectly, this method is more than 99% effective. Some of the benefits may include a decrease in pre-menstrual symptoms and menstrual pain. Also, this method can cause your period to stop completely. There are some negative factors to consider before choosing this injection. These include possible hair loss on the scalp, but increased hair-growth on the body, changes in sex drive (which can be permanent) and increased risk of osteoporosis. One of the more important considerations is that the effects of the medication may last up to a year after stopping it, so pregnancy may be delayed. Inform your physician if you have a history of depression or mood disorders as these can be intensified.
Progesterone Only Pills
These “mini-pills” don’t contain estrogen, but work in the same way as the hormone-based therapies above. However, they are not as effective in preventing pregnancy. Over the course of a year, 13% of women will become pregnant. Possible side effects are similar to those listed above. There also may be a higher risk of ectopic pregnancies. Certain health conditions however, (such as a history of blood clots in the legs or lungs), may result in a physician recommending a mini-pill over a method that contains estrogen. Fertility returns to normal immediately after stopping the mini-pill.
These birth control methods work by creating a barrier that prevents semen from entering the cervix. Again, women control their usage, as they must be in place prior to intercourse. There are few, if any, side effects from using these devices and fertility is not affected. These methods are extremely effective and reliable when used correctly and consistently. Use of a condom in conjunction with these methods is also recommended. This not only decreases the risk of pregnancy, but can also help prevent transmission of STDs. These devices are more attractive to people who wish to avoid hormonal therapies. They consist of cervical caps, female condoms, and diaphragms, all of which are intended to be used with spermicidal products.
This is a small device that is inserted deeply into the vagina and onto the cervix prior to having sex. The brand that is approved for use in the United States is called Femcap. Your provider will likely fit you for the proper size, as there are several available. Once inserted, the device stays in place by suction and the addition of a spermicidal product increases its effectiveness. This product is made of surgical silicone and is latex-free. Once in place, the Femcap should work for twenty-fours and as much sex as you want, but it should be removed within forty-eight hours to avoid an infection. The cervical cap can be used discreetly and without a partner’s knowledge. Some people report difficulty with the insertion process, but the method is about 90% effective with perfect use. It should be noted that cervical caps can cause inflammation of the cervix and they can also be dislodged during sexual activity.
Internal Female Condom
Shaped like a pouch and inserted prior to intercourse, internal female condoms are made of soft polyurethane plastic. The brand that is available in the United States is one-size-fits-all and is called the FC2 Female Condom. This product can be purchased over-the-counter and is considered an alternative to regular condoms. They must be removed very carefully so as to avoid transferring sperm back into the vagina, but they can help prevent sexually transmitted diseases and are up to 95% effective. The downside is that insertion can be difficult and there may be rustling noises during sex.
This is similar to a cervical cap in that it must be inserted prior to intercourse and used with a spermicidal product. These don’t affect fertility and can be up to 94% effective. There are three types of diaphragms and you must be fitted by a practitioner in order to determine the best one for you. The arcing spring or coil spring diaphragm is best for women with average vaginal muscle tone, the flat spring is best for women with strong vaginal muscle tone, and the wide seal is made of silicone and more suitable for women with latex allergies. Diaphragms can last two or three years provided they are washed, dried and stored properly. Diaphragms must be left in for six hours after intercourse and more spermicidal product must be inserted each time you have sex. This method can increase the risk of urinary tract infections, but otherwise the side effects are minor.
These are a family of T-shape devices that are inserted into the uterus by a physician, nurse practitioner or midwife. Health care plans sometimes pay for these and they can last for several years. They are greater than 99% effective at preventing pregnancy, but do not protect against STDs. IUDs do not cause any long-term effects on fertility. However, they can fall out or perforate the uterus and migrate, though this is rare. These have similar mechanisms of action as birth control pills. Their first line of defense is to stop ovulation, but if an egg is fertilized, these devices are designed to make the uterus uninhabitable and cause it to be expelled.
These go by the brand names: Mirena, Kyleena, Liletta and Skyla and last from three to five years. They are made of plastic, but contain a small amount of the progestin hormone levonorgestrel. The continual release of low-levels of this hormone thins the uterus’ lining and thickens cervical mucus. Some people will experience a lighter period while using IUDs.
This IUD is also 99% effective and can last between three and ten years. This version contains no hormones, but triggers your immune system to cause an inflammatory response, which is intended to expel a fertilized egg. This is the only copper IUD available in the United States. It should be noted that this particular IUD can be used as emergency contraception as well. If it is inserted within 120 hours after unprotected sex, it can prevent implantation of a fertilized egg.
Fertility Awareness Method
This is often referred to as the “natural family planning method,” or the “rhythm method” because it doesn’t use hormones or devices to prevent pregnancy. Monthly menstrual cycles are tracked to predict when heightened periods of fertility will occur. This is accomplished by using a calendar and bodily signs such as changes in mucus levels and basal body temperature. The idea is to figure out when you are most and least fertile, but it requires daily, vigilant monitoring. People who subscribe to certain religious beliefs may prefer this method, but 25% of people will become pregnant.
This method is popular with women who are breastfeeding. Moms who breastfeed their babies exclusively for six months will likely produce hormones that not only make the milk, but can also stop the ovaries from releasing eggs. Breastfeeding reduces the amount of estrogen, which is needed in higher levels in order to trigger ovulation. In order for this method to be the most effective, the woman cannot have had a period since giving birth, she must be feeding her baby exclusively with breast milk (no formula) and her baby must be under six months of age. This method does not require prescribed hormones, but it is not totally reliable.
This means no sex, but it’s 100% effective! Proponents argue that this method encourages other ways to build a relationship.
Tubal ligation is a surgical procedure where the fallopian tubes are clamped, cauterized or cut in order to prevent the egg from traveling to the uterus. This method is 99.5% effective and permanent. There is no protection against STDs, but those who undergo this procedure will likely have a significant reduction for ovarian cancer.
While women can agree to the use of this method, its success primarily lies with her partner because it requires him to remove his penis prior to ejaculation. A man must rely on his own sensations and then be responsible about “pulling out” before any semen is released. There is no protection against STDs and this method is about 73% effective.
These methods are designed to prevent pregnancy after unprotected sex. They do not guard against STDs.
Insertion of this device within 120 hours of unprotected sex can be very effective at preventing pregnancy.
“Morning After” Pills
-The ella pill contains ulipristal acetate. It works by preventing the effects of progesterone to stop ovulation. You need a prescription and it should be taken within 120 hours of unprotected sex. This pill works similarly to the hormonal methods above, but can be used retroactively to unprotected sex in order to prevent pregnancy. Though it creates an inhospitable environment for a fertilized egg, it will not stop an existing pregnancy.
-Over-the-counter versions (One-Step, Next Choice, Plan B, etc.) need to be used within 72 hours of unprotected sex, but work better when they are taken as soon as possible. These drugs contain levonorgestrel and work similarly to the hormonal methods listed above.
Mifepristone is a synthetic steroid that is used in Mifeprex, a pill (used in combination with misoprostal) that is 93%-98% effective at terminating pregnancy through seventy days gestation. This drug must be obtained via prescription and requires a follow up visit to ensure that a complete expulsion has occurred.
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Speak with your gynecologist or primary healthcare provider to determine which method (or methods) are right for you and your partner.