Family Health Guide

Not Just The Pill

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“What You’ve Been Looking For.” “Love at First Bite.” “Keep Life Simple.” “What You Should Know (That Your Friends Can’t Tell You).”

Sounds like a commercial for an online dating service, doesn’t it? In reality, those phrases are from brochures promoting different birth control methods. New options are constantly being developed, and confusion over which method is the best often follows.

Based on different types of moms, this guide will help you figure out which methods will work for you. However, you should always discuss your options and any questions with your doctor who can help you make the best choice.

pill-dispenserHow it Works

The two categories of contraception are hormonal and non-hormonal, or barrier. According to Ob/Gyn Jodie Benton, M.D., hormonal contraceptives use a combination of estrogen and progestin, a synthetic version of progesterone, to prevent ovulation and make the uterus unreceptive to a pregnancy. Non-hormonal options create a barrier between sperm and egg, preventing fertilization.

Hormonal birth control can cause side effects like headaches, nausea, weight gain, acne, cramping or irregular bleeding, but it is extremely effective at preventing pregnancy. Non-hormonal methods have few side effects, but they are not nearly as good at preventing pregnancy.

How good are hormonal methods at preventing pregnancy?

“The pill is 95 percent effective even with [imperfect] use,” says Beverly Alten, M.D. “IUDs and Implanon are 99.9 percent effective and are as good as getting your tubes tied, but they are reversible.”

Compare that to the 85 percent success rate of condoms. The sponge is about as effective as condoms, and the diaphragm is only about 75 percent effective.

Something for Everyone

Let’s look at the different categories of moms and what options might work for each. Some categories might overlap; this is where your doctor can help you decide.

Breastfeeding moms: Contrary to popular myth, moms who are breastfeeding can get pregnant.

“Breastfeeding does suppress ovulation, so there is some theoretic birth control built into that, but it is definitely not foolproof at all,” Dr. Benton says. “We see lots of patients get pregnant because they are relying on that myth.”

However, certain birth control pills may cause a decrease in your milk supply because of the estrogen in the medication. The progesterone-only pill is a good option, or you can try Mirena, ParaGard, Depo-Provera or Implanon.

The Depo-Provera shot and the Mirena IUD, or intrauterine device, are hormonal methods that contain a derivative of progesterone but no estrogen, so they are safer for women who are in high-risk categories or who are breastfeeding.

Dr. Benton says, “The progesterone products suppress ovulation, but they also thin out the lining of the uterus so that it would not accept a fertilized egg.”

If you’re using Depo, you’ll get a shot every three months. The Mirena IUD is implanted into your uterus and lasts five years. Both methods are done during an in-office visit to your doctor. Both options can lead to lighter menstrual periods or no periods at all.

ParaGard is a copper IUD that contains no hormones, but it is as effective as hormonal methods and lasts for 10 years. It’s been used worldwide for years, Dr. Alten says, but is relatively new in the United States.

Implanon is a small flexible plastic rod containing progestin that is implanted under the skin of your arm. The rod is inserted during an in-office procedure and works for up to three years. Implanon stops ovulation and thickens cervical mucus, creating a barrier to prevent fertilization.

Got-it-under-control moms: Your kids’ lunches are packed and clothes laid out the night before, and you never forget a dentist appointment. You could handle any method, and regular birth control pills are a good choice. Or try natural family planning, where you track your menstrual cycle to determine your fertile and non-fertile days. This method is also called the fertility awareness method.

“If you have regular cycles and you know when your period’s going to start, and you can predict it the month before, natural planning is awesome,” Dr. Alten says. “You’ll know when you’re going to ovulate, and you can protect yourself from pregnancy probably 90 percent of the time.”

“If done correctly, it is very effective,” Dr. Benton adds. “However, it’s very unforgiving, so if you cheat, you know what happens.”

No-time-to-think moms: You go from work to school to daycare to baseball practice then home to fix supper. Who has time to think? Mirena, ParaGard and Implanon are easy options. If taking care of business every three weeks is doable, consider the NuvaRing, a plastic ring that contains the same hormones as the pill. Wear NuvaRing for three weeks, then remove it and start your period. After a one-week break, insert a new ring.

“Unfortunately, new moms are sleep deprived and have their minds on other things besides their birth control,” Dr. Alten says. “That’s why the Implanon and IUDs are so good. The NuvaRing is really nice, too, because you only change the ring once a month and the company will send out reminders.”

At-risk moms: If you are a smoker, especially if you’re over 35, or if you are at risk of blood clots, heart disease or stroke, you should steer clear of estrogen-containing birth control. Good choices include Mirena, Depo-Provera and ParaGard.

“They still have hormones, but they don’t include estrogen, so for people at high risk these are good options,” Dr. Benton says. “However, some medical problems necessitate that you don’t use any hormonal methods at all.”

No-side-effects-wanted moms: Forget the spotting, migraines and weight gain. Barrier options like condoms or the sponge cause few side effects; however, as Dr. Alten says, “The biggest side effect is, ‘Uh-oh, we’re pregnant.’” Unless you’re OK with that possibility, you might want to investigate hormonal options. As mentioned earlier, for moms with medical complications, barrier methods may be the only option.

Definitely-done-having-babies moms: If you’re absolutely sure you never want to hear the pitter-patter of little feet again, you (or your spouse) can go the permanent route. The vasectomy for men is the least invasive and painful way to ensure no more kiddos.

“It’s done in a urologist’s office, and it’s a very, very minor procedure. They don’t even need general anesthesia,” Dr. Alten says.

The more common procedure for women is tubal ligation, or having your fallopian tubes tied. Surgery is performed under general anesthesia; recovery takes about one week. Some doctors suggest an alternative to this costly, painful surgery; Dr. Benton discusses the ParaGard 10-year IUD with her patients.

Using ParaGard instead of getting a tubal “avoids the risk of surgery, the risk of anesthesia, and sure costs a lot less,” Dr. Benton says. “Most of the time when people say ‘I want permanent birth control,’ it’s because they’re tired of dealing with birth control. It’s that they don’t want to have to worry about it anymore.”

Find What Works

If your first choice in birth control isn’t a success, try again. Among the many methods available now, you’ll find one that works.

Dr. Alten says, “Every method has its drawbacks; it’s just figuring out which drawbacks you can live with. The goal is to find a method that gives you prevention of pregnancy, and at the same time you don’t know you are using it.”v

Tiffani Hill-Patterson is a freelance writer.