Deciding when and whether to have children is essential to women’s health and well-being. Access to safe, affordable birth control is vital, and women have more options than ever for preventing pregnancy. However, sometimes the choice can be confusing: how do you know which method is best for you? Your age, overall health, need to prevent sexually transmitted infections and plans to have children are all factors to consider. Your primary care provider is an excellent resource for making reproductive healthcare decisions.
What Should I Consider When Choosing Birth Control?
We define birth control as a method, medicine or device used to prevent pregnancy. Women have a range of factors to consider when choosing birth control. According to the U.S. Department of Health and Human Services Office on Women’s Health, considerations should include:
- Do you want to have children soon, down the road or never?
- What is each method’s effectiveness at preventing pregnancy?
- What are the potential side effects?
- How often do you have sex?
- How many partners do you have?
- Your age and overall health status?
- How often do you have to take your birth control, and is it convenient?
What Are Common Birth Control Options?
We can break down birth control methods into four main categories:
- Behavior/abstinence is not having sex or timing sexual activity to prevent pregnancy. Unless you’re not having sex, “natural” family planning is one of the least effective birth control methods.
- Barrier methods are devices you put in your body to prevent sperm from reaching the egg.
- Hormonal methods prevent the ovaries from releasing eggs or thicken the mucus in the cervix to block sperm.
- Medical procedures to prevent pregnancy include tubal ligation and vasectomy.
Hormonal Birth Control Options
Hormonal birth control methods remain among the most popular because of their high effectiveness rates and overall convenience:
- Birth control pills remain one of the most popular forms of contraception. They’re convenient, low-cost and easy to use. Options include traditional birth control pills (which use a combination of estrogen and progestin hormones to prevent ovulation) and “mini pills” (which use low-dose progestin to thicken cervical mucus and prevent sperm from reaching the egg). Both types of oral contraceptives are around 91 percent effective. One challenge with oral contraceptives is that you have to take them consistently every day. Side effects can include bleeding between periods, changes to your menstrual cycle and breast tenderness.
- The birth control patch also uses estrogen and progestin hormones to prevent ovulation. But unlike the pill, the patch delivers the hormones directly through the skin, so you don’t need to take medication daily. Instead, you change your patch once a month. It’s also around 91 percent effective but may not be as effective in women over 200 pounds.
- The vaginal ring is another hormonal contraception device that’s around 91 percent effective. It’s worn inside the vagina and uses estrogen and progestin to stop the ovaries from releasing eggs. You wear it for three weeks and remove it for one week. The vaginal ring has similar side effects to other hormonal contraceptives. One upside is that you can remove it anytime if you want to get pregnant, so it’s a short-term option for women considering having children soon.
If you are not looking to get pregnant right away, or if your family is complete, there are several longer-term birth control options:
- Depo Provera shots are injections containing progestin that you get every three months from your healthcare provider. They suppress ovulation but don’t contain estrogen, with a 94 percent effectiveness rate. Side effects can include weight gain, mood changes and irregular menstrual cycles. Some women also experience a delay in fertility after getting injections. So if you think you want to get pregnant in the next year, you may want to choose another option.
- IUDs or intrauterine devices inserted by your doctor provide highly effective birth control for women not looking to become pregnant in the short term. IUDs offer low maintenance and low stress once inserted. There are two types of IUDs available: hormonal IUDs, which can last 3 to 5 years and copper IUDs, which can last up to 10 years. Copper IUDs don’t contain hormones and use copper ions to kill sperm. They are an excellent choice for women who are done having children but not ready for sterilization. Side effects include missed or irregular periods. Rare cases of pelvic inflammatory disease have been linked to IUDs.
- Implants are one of the most effective temporary birth control methods. They’re highly effective (around 99 percent) and long-lasting. Implants are hormonal rods inserted into your upper arm by your healthcare provider and use progestin to prevent ovulation. An implant lasts up to three years, but your provider can remove it if you want to get pregnant. Implants have been linked to blood clots, stroke and breast cancer in some high-risk women.
- Sterilization for women (tubal ligation) or men (vasectomy) is a highly effective way to prevent pregnancy for people who do not want children or have completed their family. If you are done having children, there is almost no chance of becoming pregnant and no hormonal treatment is required. Both require a surgical procedure with some pain during recovery and potential complications from surgery. We don’t recommend these options if there’s any chance you want to have children down the road.
Barrier Birth Control
- Diaphragms/Cervical Caps: Technological advances are bringing back barrier methods for women who want to avoid hormonal birth control. A diaphragm is a cup (similar to a menstrual cup) that you place on your cervix. The diaphragm is making a comeback as 21st Century models are easier to insert. Cervical caps work similarly but are smaller and can be left in place longer. Diaphragms are around 88 percent effective, and cervical caps are 77 percent effective. Both work best when paired with a spermicide. One upside of barrier methods is that they avoid hormonal effects on your body. Also, you only use them when having sex instead of having to think about birth control every day. They can be cheaper for uninsured or underinsured women than hormonal birth control. The downsides include having to remember to put it in every time you have sex. They can also cause urinary tract or vaginal infections.
- Condoms remain a valuable form of birth control and are the only contraceptive that prevents sexually transmitted infections. They are inexpensive and available over the counter. When used alone, effectiveness rates are relatively low. So many women opt to pair condoms with hormonal birth control to provide an extra barrier and prevent STIs. Condoms are a must if you have more than one sexual partner.
Do I Need Birth Control Over 40?
Until you have reached menopause and haven’t had a period for a year, you still need to take steps to prevent pregnancy. However, our birth control needs change as we age. Oral contraceptives and other hormonal birth control have been linked to blood clots and other health risks in some women over 40, especially if they smoke. For older women whose families are complete, popular methods include tubal ligation, a vasectomy for their partner, implants and IUDs.
Confused About Birth Control? Your Primary Care Provider Can Help
Figuring out which contraceptives work best for you can be an overwhelming decision. Talking with your primary care provider is an excellent first step. They can offer insight into the pros and cons of various methods, considering your age, overall health, lifestyle and reproductive goals. Reproductive health is an essential part of holistic well-being. The providers at Comprehensive Primary Care, with offices throughout the DMV region, are ready to help you find the best options to meet your needs at every stage of life.