Editor’s Note: We’re excited to welcome back Dr. Jessica Shepherd for her second column! This month, she’s tackling a subject most women think about almost every day (at least if you’re on the pill): birth control. Here, she’s sharing tips for choosing the best method for your body, and important questions to raise at your next GYN appointment.
You know the conversation; the ones with our girlfriends when we discuss birth control and think of those moments after sex that we were not on birth control.
Since the first oral contraceptive approved by the US Food and Drug Administration (FDA) as contraception in 1960 we have come a long way. From 1965 when it was only for married couples to 1972 when it was legalized for all citizens of this country, irrespective of marital status we now have access to various more types than ever and those that are for short term, long term and permanent.
A recent study in the journal Human Reproduction found that two-thirds of unplanned pregnancies occur among women who use birth control but either utilized it incorrectly or were using methods that didn’t mesh with their lifestyles.
So now the question is which pregnancy prevention method is right for you? Here is some of my best advice on how to choose the right birth control method.
First things first are having that conversation with your gynecologist or health care provider. What you want out of your birth control and how you will integrate it into your life is the most important step. Make sure to discuss issues like high blood pressure, your smoking habits, obesity, liver disease, diabetes or a history of blood clotting disorders and breast cancer as they can have an impact on your choice.
Choosing the appropriate contraceptive is a personal decision and although your friends and family can make good suggestions, the best decision should be between you and your doctor.
Contraceptive options include:
- Hormonal contraceptives (such as oral contraceptives, skin patch, vaginal ring, implant, and injection)
- Intrauterine devices (IUDs), which contain either a hormone or copper
- Barrier devices or nonhormonal options with or without spermicides (such as diaphragm, cervical cap, sponge, and condom)
- Permanent female sterilization (tubal ligation, Essure)
What we also need to consider is that most women exercise is “typical use”. This is what happens in real life….. the moments when we didn’t use the condom, forgot to take our pill for a day or two or didn’t make the appointment at the doctor’s office for the refill on our prescription. If there is a chance you didn’t use it correctly and consistently, then that opens the door for failure of your birth control and unplanned pregnancies.
Here are some tips to choosing and also points to bring up at your next visit with your gynecologist.
- Are you over the age of 35? The birth control pill may not be the best choice for you
- Do you have hypertension (high blood pressure)? Birth control options with estrogen should be addressed individually before starting
- Do you experience acne? Birth control pills can help clear the skin by binding to testosterone, and therefore decreasing it in the bloodstream
- Is your BMI greater than 30? Make sure to discuss options as with obesity, the levels of circulating hormones may be decreased and may not be able to provide optimal pregnancy protection
- Do you suffer from migraines with aura? Consider other options if you have focal neurologic symptoms, smoke, and are older than 35 years
- Do you suffer from endometriosis? Consider a long acting birth control with progesterone such as the progesterone coated IUD or the single-rod implantable contraceptive device to help decrease estrogen levels and to get a maintained level of decreased ovulation
- Is there any condition that you have where you cannot take hormones? Consider the nonhormonal IUD which can be an excellent option.
So what type is best for you? That is a decision that requires discussion with you and your gyno so you can go over medical history, and find out what contraceptives are the most effective, safe, simple and fit into your life. Unfortunately, the perfect method does not exist and the condom is the only birth control method that provides protection against sexually transmitted diseases (STDs) so remember to practice safe sex and get STD tested every year or when changing partners. Advances in birth control have created more choices than ever and there is always an option for you and your needs.