Health Matters: Beyond the pill

December 26, 2012

By Taylor Stanton

Medical student and member of the student group, Physicians for Social Responsibility, University of Illinois College of Medicine at Rockford

With all of the attention on birth control coverage in recent months, it is important for all of us to understand what menu of option is available for women today. Finding the best contraceptive can be as easy as asking your physician about some of the following options and asking if they are right for you.

In this article, we will review some of the most effective reversible methods for birth control. And the best part about all of them? Under the new health care law, most insurance plans will now cover these vital components of family planning and women’s health.

The pill is an oral hormonal contraceptive that is taken once a day to prevent pregnancy. A great deal of research exists behind its efficacy, and there are many different formulations from which to choose. What that means is that the pill is incredibly safe to use, very effective and your doctor can work with you to try to find which brand works best with your body.

One important downside of the pill is that for it to work, it must be taken at the same time every single day. Even the most diligent woman can miss a dose now and then, and that raises the chance of pregnancy significantly.

Plenty of other options are available that are more effective, have fewer side effects and do not need to be taken daily that we will explore here.

The hormones estrogen and progestin that are important in preventing pregnancy can be delivered to the body in a number of ways. Just as effective as the pill are the ring and the patch. The ring is inserted once a month and the patch is worn on the skin and changed once a week. They still require some planning, but remembering to do something weekly or monthly may be easier than daily.

The shot and the implant are also some longer-term options that are more effective than the pill. The shot is given every three months, but does come with more side effects than other options. The implant is a small, thin, flexible tube inserted just under the skin by a physician and stays in place for up to three years. If pregnancy is desired at any point in those three years, a physician can remove the implant, and fertility returns quickly after.

One of the most effective and longest lasting reversible methods is the Intrauterine Device (IUD). One option, Mirena, contains hormones and is left in place for up to five years, while another option, the Paragard, has absolutely no hormones and may be left in place for 10 to 12 years.

As with the implant, an IUD can be removed at any time by a physician, and fertility returns quickly. The Mirena may even stop periods altogether after the first few months, which is not risky and may even be an enjoyable side effect.

IUDs have been around since the 1960s and remain the most effective form of reversible contraceptives, but they are frequently overlooked. One reason may have been the hefty price tag — hundreds of dollars without insurance. But with the implementation of the new health care law, that barrier will be removed for most women.

As always, it is a great idea to talk to your physician about any questions you have about contraceptives. Possible side effects come with all of these options, so make sure you ask your doctor about these, too. When you do go, do not be afraid to ask about all the different options available, and they can work with you to find just the right fit for your unique body and lifestyle.

For more information, you can visit this site: http://womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.cfm.

Birth control methods and failure rates

Following are birth control methods with their respective failure rates — the number of pregnancies expected per 100 women.

Sterilization surgery for women — Less than 1 pregnancy

Sterilization implant for women (Essure) — Less than 1 pregnancy

Sterilization surgery for men — Less than 1 pregnancy

Implantable rod (Implanon) — Less than 1 pregnancy; might not work as well for women who are overweight or obese

Intrauterine device (ParaGard, Mirena) — Less than 1 pregnancy

Shot/injection (Depo-Provera) — Less than 1 pregnancy

Oral contraceptives (combination pill: the pill continuout/extended use: “no-period pill,” and progestrin-only pill: “mini-pill” — 5 pregnancies; being overweight may increase the chance of getting pregnant while using the pill

Skin patch (Ortho Evra) — 5 pregnancies; may not work as well in women weighing more than 198 pounds

Vaginal ring (NuvaRing) — 5 pregnancies

Male condom — 11-16 pregnancies

Diaphragm with spermicide — 15 pregnancies

Sponge with spermicide (Today Sponge) — 16-32 pregnancies

Cervical cap with spermicide — 17-23 pregnancies

Female condom — 20 pregnancies

Natural family planning (rhythm method) — 25 pregnancies

Spermicide alone — 30 pregnancies; it works best if used along with a barrier method, such as a condom

Emergency contraception (“morning-after pill,” “Plan B One-Step,” “Next Choice”) — 1 pregnancy; it must be used within 72 hours of having unprotected sex and should not be used as regular birth control — only in emergencies

From the Dec. 26, 2012-Jan. 1, 2013, issue

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