Evelyn Minaya, MD, OB/GYN Vice President of Women Caring for Women
There are different kinds of birth control and many different options in today’s world. Choosing one that is right for you has to depend on your lifestyle, the time that you want to invest in it, and, sometimes, where you are in your relationship. Things like family history and personal medical history also influence what type to take. While birth control of any kind is very effective (up to 99%), a lot of them are user dependent. That means that once you decide on the type of birth control you want to use, you should commit to it so it can work the best for you.
In general, there is no age limit to birth control since you could use it for so many other reasons than just preventing pregnancy. Some methods of birth control can be used to help anemia, fibroids, heavy periods, acne, irregular periods, cramps (dysmenorrhea), endometriosis, prevention of endometrial and ovarian cancer, and, for some people, premenstrual syndrome.
Most birth control methods are reversible with the exception of the permanent solutions (more on that later). You can choose how quickly you want to reverse it by talking to your physician. For example, you might want to choose the pill if you plan to get pregnant shortly after you get married. In this case, you have to come off the pill one month before trying. On the other hand, you have to wait three months when using the progesterone-only injection.
Because there are so many misconceptions about birth control, it’s imperative to review the options that are available to you and understand how they work.
Hormonal Birth Control
This category includes pills, injections, intravaginal rings and patches. One of the biggest misconceptions about this birth control method is that it tricks your body into thinking that it is pregnant. Hormonal birth control tells the brain that it is getting enough hormones (meaning estrogen and progesterone) from the pill. The brain, in response, will not signal the ovary to produce hormones or to ovulate. That is how it prevents a pregnancy. Since the hormones in the medications are far LESS than what we normally produce from the ovary, it protects against endometrial cancer. Because the brain needs to have steady hormone levels every day, in order for it not to signal the ovary, birth control pills have to be taken every day. The intravaginal ring can be left for three weeks. Progesterone-only injections are given every three months. Patches are changed every week.
There are lots of benefits to hormonal birth control. First, it can really reduce the flow of your period and reduce cramps significantly. It can also make you very regular so that you can predict when your period is coming. This could be especially true for young girls that engage in sports, making their period more manageable.
When you take hormonal birth control, you can reduce your risk of endometrial and ovarian cancer and not increase your risk of breast cancer. This can be very important to women in their perimenopausal years especially because hormonal fluctuations in progesterone can lead to increased levels of unopposed estrogen – increasing the risk of endometrial cancer. Women with a family history of ovarian and endometrial cancers can also benefit, as well as women with BRCA genes that are not finished with child bearing.
Women of all ages can use birth control as long as they are dedicated to taking it properly; it must be taken every day, at the same time every day. Women with very busy and unpredictable schedules may not benefit from this method of birth control.
Women that smoke should not be taking hormonal birth control because it can increase your risk for heart attack and stroke. Women with a family history of clots in the legs should also not take this method of birth control. The pill can increase your risk for a deep vein thrombosis, although it’s very rare. In some women it can increase the incidence of gallbladder disease.
This category includes condoms, female condoms and diaphragms. Condoms (male or female) with spermicide are very effective against pregnancy, up to 99% of the time. It also protects you against sexually transmitted infections including the human papilloma virus (HPV). Female condoms are a little more cumbersome and not very popular. Diaphragms, which have to be inserted 30 minutes before intercourse and taken out at least 8 hours later, are about 85% effective. This, however, can lead to infections in the vagina.
Barrier methods are very good when you are not in a committed relationship. We encourage women of all ages to use barrier methods so they can prevent infection.
Intrauterine devices fall under this category. There are basically two types. One is for contraception only: the copper IUD. This stays in the uterus for 10 years. It works by forming an inflammatory response to the uterine lining, thus preventing implantation; it is also believed to deactivate the head of the sperm. The progesterone IUD is good for five years and can control heavy bleeding by making patients have no period over time. IUDs are inserted and can be removed in the office. It usually takes about five minutes!
IUDs work very well for women that have finished with their child bearing but do not want a permanent solution. Women that have never had children or are not in a committed relationship should be discouraged from using it. If the patient changes her mind and wants to become pregnant, that can easily be accomplished by removing the IUD from the uterus.
This includes tubal ligations and vasectomies (for men). These procedures are both surgical in nature. Tubal ligations involve the cutting, burning or obstructing the fallopian tube, thereby inhibiting the egg and the sperm from meeting. Vasectomies work in a similar fashion except the tube is called the vas deferens. The biggest misconception that most people have is that the tubes are “tied” as if to imply that you can untie them and then become fertile again. In general, the intention of this procedure is to significantly reduce the possibility of the tubes repairing themselves.
Only you know what kind of birth control works for you. This is a great opportunity to talk to your doctor about what options are best for your body and your lifestyle.