Medicine: All About Birth Control

March 3, 2016

I started my OB/GYN rotation last week. If it was up to me, I would just spend the entire day catching babies. I’m not planning on doing OB, but I love seeing the process of life coming into the world. That sounds weird, maybe not seeing all of it, but the end result is definitely awesome. I am always so thrilled to watch parents as they hold their baby for the first time. There is seriously nothing like it in the world and I have felt so privileged to have been allowed to play an active role in such momentous and intimate moments.

Unfortunately, my entire day cannot be spent doing this and much of the day is also in the clinic – which I also love, but not as much. You can’t love it all people. Needless to say, I see a lot of patients inquiring about fertility and contraception and there is a LOT of information out there, and quite honestly, a lot of it is WRONG.

So here are 7 forms of birth control and a little information about each one. Hopefully it serves as a helpful guide.

IUD: The two most common types are the copper IUD and Mirena. Work by changing the cervical mucus to prevent pregnancy.

Pros: Effective for 5 years, effective in most patients in preventing monthly periods, no adverse systemic effects

Cons: Increased risk of extrauterine pregnancy if failure, risk of uterine perforation with placement, may have increased blood loss in first few cycles, may be unknowingly expelled, possible ovarian cysts

Contraindications: Suspected pregnancy, uterine structural abnormality, pelvic inflammatory disease,  suspected uterine or cervical abnormal cell growth, history of breast cancer, untreated vaginal infection, liver disease

Failure: 0.1% with Mirena, 0.6% with copper

Oral Contraceptive Pills: For a lot of people, this is the first type of contraception they think of. Most packs include 28 days of pills. Some have a consistent hormone level, others vary throughout the month. Most will have a placebo week at the end to allow women menstruate.

Pros: Promotes menstrual regularity, reduced risk of pelvic inflammatory disease, treats ovarian cysts, treats benign breast disease, decreased risks of endometrial cancer and ovarian cancer, decreased  anemia

Cons: May worsen migraines, depression, hypertension, cholesterol, and diabetic control

Contraindications: History of DVT, pulmonary embolism, breast cancer, congestive heart failure, smokers over the age of 35

Failure Rate: 0.1-5% – This really depends on how consistent women are with taking their pills within a set time frame (generally within the same 3 hours each day).

Depo-Provera: a Progestin-only form of birth control. Shots are administered every 3 months. Pregnancy must be excluded before the shot can be administered. If you are not on some other form of contraception before receiving your injection, you must be abstinent for 7 days.

Pros: No need to take a pill every day, no estrogen effects, decreased endometrial cancer risk, no effect on breast milk

Cons: It may be difficult to get pregnant in the year following cessation of Depo injections, menstrual irregularity (some women will have no period, others will have spotting of varying degrees), weight gain

Contraindications: History of blood clot, suspected pregnancy, clotting disorder, history of breast cancer, significant liver disease

Failure rate: 0.2%

Implanon: Progestin-only form of contraception. A match-sized implant is inserted into the arm near the biceps.

Pros: Effective for 3 years, sufficient hormone levels achieved within 24 hours, prompt return to fertility, no effect on breast milk

Cons: Irregular bleeding, headaches, vaginitis, weight gain, acne

Contraindications: History of breast cancer, history of bloodclot, vascular diabetes

Failure rate: 0.2-1.1%

Nuvaring: A ring that can be used 3 weeks at a time, before being removed for a week. Combination of estrogen and progestin. Works by changing cervical mucus and uterine lining.

Pros: No daily pills, less estrogen than in pills

Cons: Possible risk of headaches, vaginal irritation, may unknowingly be expelled, must use backup methods if out for more than 3 hours

Contraindications: History of blood clot, smoker over 35 years old, uncontrolled hypertension, coronary artery disease, clotting disorder, liver disease, pregnancy, breast cancer

Failure Rate: 2%

Fertility Awareness: Uses knowledge of woman’s cycle and body to predict fertility. Should record 6 cycles to establish pattern. Can use mucous consistency or changes in body temperature to predict ovulation.

Pros: No gap in fertility, no hormones, requires complete abstinence if not trying to get pregnant.

Cons: Requires organization and consistent tracking, requires complete abstinence if not trying to get pregnant.

Contraindications: None

Failure Rate: typical use = 25%, perfect use = less than 5%

Abstinence: This is the only 100% effective way of preventing pregnancy and sexually transmitted diseases

*** Common Misinformation: For a young healthy woman, artificial contraception will not increase your risk of blood clots. The types that carry an elevated risk are those with an estrogen component. These risks apply mainly to smokers, people with underlying clotting disorders, and people with prolonged periods of being sedentary. Other than Depo-Provera, artificial contraception will not impact your fertility long term. It is true that you may have a few months of menstrual irregularity while part of your brain wakes back up and produces hormones on its own. However, the vast majority of women who have difficulty conceiving after being on birth control had underlying issues with their cycles.

I hope this has been helpful! Please let me know if you have any thoughts or questions!

XOXO – Emmy Lou Lou

 

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