Nov 19, 2018
It could be argued that nothing has had a bigger impact on the sex lives of men and women than the first oral contraceptive approved by the U.S. Food and Drug Administration back in 1960. Since then, birth control has come a long way. But as Marissa Kirchenbauer, a certified family nurse practitioner (FNP-C) who specializes in women’s health at USMD Denton North, explains, “The best birth control is one you’re going to take.”
Fortunately, there are a lot of different choices for women of all ages. Whether you’re young and just becoming sexually active or already have children, there are good options to fit your contraceptive needs. Beyond the prevention of pregnancy, birth control is also used to treat gynecological issues.
“Birth control is often used to help treat women who have a history of cysts, fibroids or other gynecological issues such as painful or heavy menstrual cycles,” Kirchenbauer explains. “But whether you’re considering contraceptive options or wonder if the hormones in birth control can help alleviate painful gynecological symptoms, the first step is to talk with your care provider.
Choosing the right type of birth control
For generations, women relied on the rhythm method, condoms or celibacy for birth control. Now there are many more reliable and convenient methods.
Today, birth control methods are divided into two categories—hormonal and non-hormonal (with the exceptions of permanent sterilization).
Non-hormonal options include: the copper interuterine device (IUD); condoms, diaphragm, and withdrawal method. While the copper IUD is very a very effective form of contraceptive, the effectiveness of the other non-hormonal methods is usually lower due to human error.
Hormonal methods are a combination of estrogen and progesterone or progesterone only options. “While many women tolerate combination therapy well, there are always exceptions and that is where providers can really tailor these methods to an individual’s needs,” Kirchenbauer explains. “For example, estrogen therapy is not appropriate for someone who has a blood-clotting disorder. Some patients experience migraines, mood swings, irregular bleeding, and weight gain on certain birth control methods.”
Another important aspect to consider in choosing a birth control method is the reason you are seeking it.
“If it’s for family planning, your choice may vary depending on whether you plan to conceive in the next year rather than in the next five years,” Kirchenbauer says. “If you have concerns about bleeding, this will also factor into the method we consider. Talking to your healthcare provider about any past or current medical conditions is the best way to ensure that you’re on the birth control that is best for you.”
Depending on the woman’s age, stage of life, and preference, birth control options may include:
Hormones—a combination of estrogen and progesterone or progesterone only—packaged in a little pill provide exceptional contraception. Although some women are sensitive to hormones, “There’s a variety of pills that offer enough differentiation in hormone levels that we can usually find one that will work for everyone,” Kirchenbauer says. “If you have headaches or migraines and can’t tolerate estrogen, there’s a very low estrogen or progesterone-only pill that works well. It’s also a good option for women who are breast feeding because it doesn’t affect the milk supply or the baby.”
The same hormones that prevent ovulation, are also very effective in helping manage painful and heavy menstrual cycles, acne—along with reducing ovarian cysts, uterine fibroids and gynecological issues.
“The pill is an excellent option for woman 30 and younger—including women who have irregular cycles or who are going off to college. You just have to remember to take the pills,” says Kirchenbauer.
If you don’t like to take pills—or if you worry you may forget to take yours every day—the patch might be a good alternative. A slim piece of plastic, it gives off hormones that prevent the ovaries from releasing eggs. For three weeks in a row, a fresh patch is placed on the stomach, upper outer arm, upper back or buttock. The fourth week, the patch isn’t worn.
“The important thing with the patch is remembering to apply it correctly and at the right time—the same day for three weeks in a row, skip it for one week, then start the three-week cycle again.”
A small bendable ring is inserted into the vagina and left in place for three weeks. It, too, gives off hormones that prevent ovulation. The ring is removed for the fourth week, then a new ring is inserted for the next three-week cycle. “The ring is a good option for women of all ages,” Kirchenbauer notes. “But as with the pill and the patch, you have to remember to really follow the schedule. Forgetting to insert and remove the ring at the appropriate times will reduce the it’s efficacy.”
A simple injection in the doctor’s office provides contraceptive protection. The Depo Provera shot contains progestin that prevents ovulation and thickens the cervical mucous that helps block sperm from reaching the egg. Since it only contains progestin, it’s a good option for women who are sensitive to estrogen. The drawback is that is has to be administered regularly every three months. Some studies have shown that the shot can cause bone loss, so older women may not want to use it as their form of birth control.
Good for three years, the Nexplanon arm implant only contains progesterone. “Implanting Nexplanon is a simple office procedure,” Kirchenbauer explains. “We numb the arm in the office and insert it and then they’re good to go. It’s a really great option for young women who don’t want to have to think about taking birth control every day.” Women may experience some irregular bleeding for the first couple of months, but after that most women don’t have a period on it after all.
Inter-Uterine Device (IUD)
An IUD is a little T-shaped piece of plastic. Once inserted in the uterus, it prevents sperm from fertilizing an egg. “If you’ve had a child and are looking for a long-term birth control, don’t want to take a pill every day, then IUDs are a good option,” says Kirchenbauer. “You don’t have to think about birth control every day. Most women on the IUD have very light periods or no period at all—and a lot of women like that.”
The IUD is inserted during a quick and simple office procedure in the doctor’s office. With an IUD, some women experience spotting between periods—especially during the first few months of use. Cramps, backache, infections and slippage are other possible side effects. There are several IUDs to choose from, including:
ParaGard is made of plastic and a small of safe, natural copper. It’s the only IUD that is 100 percent hormone-free. Instead of hormones, ParaGard releases copper ions that kill sperm—thereby interfering with egg fertilization and implantation. It can remain implanted for 10 years. “It’s a very effective contraceptive, but not necessarily the best if you have heavy cycles or cysts,” Kirchenbauer advises. “It’s really good for women who’ve had children, but it’s not my favorite option for women who’ve never had a baby because it’s a bit bigger and stiffer so it can be uncomfortable if your uterus has never experienced any stretching.”
Highly effective, but low in hormones, Kyleena is estrogen free, and prevents pregnancy for up to five years. “The IUD is implanted during a simple in-office procedure,” says Kirchenbauer. “It’s a good option for both women who have and who haven’t had children. The great thing about it is you don’t have to think about it once it has been inserted into the uterus—and neither you or your partner should feel it during sex. A simple monthly self-check ensures it is still properly in place. It’s also easily removable if a woman changes her mind and no longer wants to be on birth control.
Skyla, is another IUD option that works like Kyleena. Estrogen-free with a low-dose progestin hormone, Skyla prevents pregnancy for up to three years once implanted in the uterus during a simple in-office visit with your care provider. It is a good option for women who have not had children.
Mirena is another very popular IUD that prevents pregnancy for up to five years. Many women on this type of IUD do not experience a regular period once the device is placed. It’s a good option for woman who have had children.
Effectiveness of birth control
In a perfect world, all forms of birth control should be over 99 percent effective,” says Kirchenbauer. “But human error—forgetting to take your pill, or not going in for the shot on time—reduce their actual effectiveness. Studies have shown that IUD and implants are more effective than the pill, ring, patch and shot only because they eliminate human error. At the bottom of effectiveness is the condom because condoms can break, there can be a hole in them, they can fall off, or they aren’t used.”
Birth control and sexually transmitted diseases
“It’s important to remember that no form of birth control—with the exception of a condom—protects your body from sexually transmitted diseases,” Kirchenbauer warns.
Many experts say using a condom in combination with birth control is the best way a woman can protect herself from STDs and pregnancy.
“I encourage women to really take responsibility for their sexual health and look out for their well-being.”
Do you have questions about which birth control is right for you? Marissa Kirchenbauer, FNP-C at USMD Denton North, is here to help. Please call 940.387.8763 to schedule an appointment.