Health Explainer: Birth Control Options

October 21, 2019
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There are multiple types of contraception available for women. The most effective ones are going to be the longer acting forms that you don’t have to remember to take every day.

These more effective forms of birth control are the Nexplanon (a small progesterone-containing rod that goes in your arm and lasts for three years) and an intrauterine device, commonly called an IUD. There are two categories of IUDs – hormonal and non-hormonal (copper IUD). The hormonal IUDs (Skyla, Kyleena, and Mirena) contain progesterone and last 3-5 years. The copper IUD lasts 10 years. Your doctor can remove any of these devices at any point, should you decide you want to become pregnant or don’t like the side effects.

The Nexplanon is over 99% effective in preventing pregnancy. The most common side effect is irregular bleeding and is the main reason patients may have the device removed before three years. 

The copper IUD and hormonal IUDs (Skyla, Kyleena, and Mirena) are also over 99% effective in preventing pregnancy. Most people tend to tolerate these devices very well. Hormonal IUDs are associated with shorter and lighter periods with less cramping. That being said, they are commonly used to treat women who have problems with heavy or painful periods. The two most concerning side effects of IUDs are uterine perforation at time of insertion and pelvic inflammatory disease (PID). Fortunately uterine perforation is rare and occurs in about 1/1,000 insertions. If the insertion is difficult, your doctor may suggest that the device be placed with ultrasound guidance to help minimize your risk of a perforation. PID occurs in less than 1% of patients with an IUD, and it’s why your doctor may check for gonorrhea and chlamydia prior to the insertion. Other side effects may include ovarian cysts and pelvic pain.

Depo-Provera is another form of longer acting birth control. This is commonly referred to as “the shot.” It is a shot of progesterone that lasts 3 months. The most common side effects include irregular bleeding and weight gain greater than 10 pounds. These are the two reasons patients decide to switch to a different method. There is also some concern that this can cause a loss in bone mineral density if used for longer than 2 years.

The next most effective form of birth control is the NuvaRing. It is a vaginal ring that contains estrogen and progesterone that lasts for 3 weeks. You remove the ring the fourth week to have your period.

You may also have heard about the patch, which is an estrogen and progesterone form of birth control. The patch can be placed anywhere on the body except the breasts. It is switched out weekly, and the patient leaves it off the fourth week to have a period.

The most well-known form of birth control is the pill. This is also one of the least effective forms of birth control because it has to be taken on a daily basis and at the same time each day. This is also the reason most people chose to switch to a different form of birth control. Forgetting a pill can lead to pregnancy or irregular bleeding.

As a general rule, most birth control options are going to contain side effects that include headaches, vaginitis, weight gain, acne, breast pain, and abdominal pain.

The only non-hormonal forms of birth control are a tubal ligation, the copper IUD, condoms, and a vasectomy for your partner. It’s important to know that a tubal ligation is considered to be permanent. So if there is a chance you may want another child, a tubal ligation is not a good option for you. The only form of birth control that can prevent STDs is a condom.

Occasionally I will get questions as to whether or not birth control is associated with cancer. According to the American College of Obstetricians and Gynecologists, it is safe to use hormonal forms of birth control in patients with a family history of breast cancer or in those who test positive for the BRCA gene but have no personal history of breast cancer. Studies have also shown that birth control pills can actually reduce your risk of ovarian cancer. If, however, you have had breast cancer and need birth control, a hormonal option would not be appropriate for you.

It is important to talk to your doctor about the various forms of birth control and which one is right for you based on your medical history. For example, options containing estrogen (pill, patch, and ring) are not appropriate for someone who has uncontrolled hypertension (high blood pressure), migraines with aura, history of a DVT or pulmonary embolism (blood clots in your legs or lungs) or who are over the age of 35 and smoke.  Generally speaking, the progesterone containing forms of birth control (Nexplanon, IUD, and Depo-Provera) are safe for people with multiple health issues. In fact, we often use the IUDs in these situations as they offer the least hormone exposure per day.

Dr. Kehaya is board-certified in obstetrics and gynecology and is welcoming new patients. For more information or to schedule an appointment, call 910.763.9833 or visit 

Categories: Your Health
Topics: GYN

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