Pick Birth Control that Matches Your Lifestyle

When a woman considers birth control methods these days, the options are many.

Science has improved contraceptive methods in ways that were unthinkable just half a century ago. Yet most gynecological patients think of “The Pill” as the automatic choice and, among older women, sterilization.

In fact, according to a new report from the National Center for Health Statistics, sterilization, an irreversible contraceptive method, was the most common choice for the 47 million women between 15 and 49 years of age. Almost 19 percent using birth control had had this surgery, and that portion jumped to 40 percent among women ages 40 to 49.

This doesn’t come as a surprise to Dr. Karla Maguire, a gynecologist and obstetrician with the University of Miami Health System. “The convenience is very attractive,” she explains. “With some other forms [of birth control] there are many other steps to take and with every step the failure rate increases. Women prefer to keep it simple if they can.”

However, she adds, women would do well to consult with their gynecologist to discuss other options.  “If you’re 100 percent sure you’re finished having children, then I definitely recommend sterilization,” says Dr. Maguire, who also has a master’s degree in public health. “But if you’re not, or you’re young, I counsel more about other just as effective and reversible options. Studies have shown that there’s a high degree of regret for women under 30 who have undergone sterilization.”

Most women have used a birth control method in the United States

According to the Guttmacher Institute, an organization that advances sexual and reproductive health in the U.S. and abroad, more than 99 percent of women aged 15 to 44 who have ever had sexual intercourse have used at least one contraceptive method. Among women of reproductive age, 60 percent are currently using birth control.

If you’re wondering what birth control method is best for you (or your partner), Dr. Maguire suggests you have a frank talk with your gynecologist. Be sure to provide as much information as possible about your personal life. There are three elements you should consider in that discussion. “Ask yourself what are your future plans for children, what medical conditions do you have, and what side effects are you willing to accept,” she says. (Among the medical conditions that influence birth control choice are diabetes, hypertension, and a history of seizures.)

A guide on available birth control methods

• Intrauterine devices (IUDs) have a low failure rate, 0.2 to 0.8 percent, according to the CDC. There are two kinds: one brand releases copper, others release the hormone progestin. Both types prevent sperm from fertilizing the egg. A physician places the T-shaped device in the uterus. The copper-release device works for 10 years and the hormone-release devices work between 3 to 5 years. Dr. Maguire is seeing more young women choosing IUDs because they’re long-acting, safe, and practical, while also giving those who eschew hormones an alternative. Patients who use hormone-release devices tend to have lighter periods.

• Implants are a thin rod inserted under the upper arm’s skin. It releases progestin and is also highly effective, with a minuscule 0.05 percent failure rate. The implant lasts about three years and it’s becoming more popular among younger woman, according to Dr. Maguire.
• Sterilization, the most-used contraception, is a surgical procedure in which women’s fallopian tubes are closed or blocked so eggs cannot be fertilized. It also has a low failure rate of one percent. The biggest setback, as Dr. Maguire mentioned earlier, is that it’s irreversible. And because it’s a more complicated procedure in women, she often suggests that a male partner consider a vasectomy, an out-patient procedure.
• An injection of the hormone progestin every three months is also highly effective, failing only six percent of the time. It works by preventing ovaries from releasing eggs and thickens cervical mucus, which, in turn, blocks sperm. However, Dr. Maguire notes that it is the only method linked to weight gain. Studies have shown that one in five women report extra pounds while on the injections.
• The Pill, first introduced in 1960 and celebrated (or blamed) as a factor in the sexual revolution of the ‘60s and ‘70s, is the second most common contraceptive method, with 13 percent of women using it, according to the NCHS study. Pills may use either progestin alone or estrogen and progestin together. The former kind thickens cervical mucus and thin the uterine lining making it more difficult for eggs to implant. The combination pills work in a similar manner but also suppress ovulation. The failure rate is nine percent, but the biggest issue, Dr. Maguire explains, “is remembering to take them, and they’re only as effective if they are used correctly.” The Pill’s side-effects may find unexpected benefits. It reduces acne and tends to regulate menstruation.
• The skin patch, which releases estrogen and progestin is put on once a week for three weeks, with the fourth week off for a woman to have her period. It fails nine percent of the time.
• The vaginal ring is placed in the vagina to release estrogen and progestin. Like The Pill, it is used for three weeks and then removed on the fourth week for menstruation. Some women may prefer this, Dr. Maguire says, because it’s not a daily task.
• Diaphragms, condoms, and spermicides are considered barrier methods — that is, they block the sperm from getting to the egg. The diaphragm, with a 12 percent failure rate, must be inserted into the vagina with spermicide, but it has seen a drop in popularity because it’s a mood-breaker. While both male and female condoms have a higher failure rate (18 percent and 21 percent respectively), they bring an added bonus. “They also prevent STDs,” Dr. Maguire says, “and they can be easily bought over the counter without having to see a doctor.”

In the end, a woman must decide on the contraceptive that best suits her lifestyle. “Birth control works only if you use it,” she says. “Everyone is different, so the best thing to do is schedule a consult with a gynecologist who can talk you through it.”

Ana Veciana-Suarez, Guest Columnist
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: Ana Veciana Suarez, birth control, Dr. Karla Maguire, gynecology, sterilization, women's health