Monday Medical: Birth control basics
For Steamboat Pilot & Today
Editor’s note: This is Part 1 of a two-part series on birth control. Part 2 covers health issues birth control can help treat.
With so many options, finding birth control that works for you is easier than ever.
Below, Dr. Mary Bowman, an obstetrician/gynecologist at UCHealth Women’s Care Clinics in Steamboat Springs and Craig, outlines various types of birth control.
Abstinence, or avoiding intercourse, is the only way to completely prevent pregnancies. While other birth control methods come close, only abstinence has a 100% success rate.
Natural family planning
In this method, a woman times her cycles based on changes such as temperature and cervical mucus and avoids intercourse when she believes she is ovulating. While it can help prevent pregnancy, it is “notoriously unreliable,” Bowman said.
These methods physically keep sperm from reaching an egg and include condoms and diaphragms.
“These are nonhormonal methods and don’t require a prescription from a physician,” Bowman said. “But they don’t work if they’re not used.”
Condoms have a “typical use failure rate” of 13%: that means 13 out of 100 women experience an unintended pregnancy when using condoms in the typical way, which may be inconsistently or incorrectly. Diaphragms have a typical use failure rate of 17%. Both should be used with spermicide.
Patient-controlled hormonal methods
Birth control pills are much more effective than barrier methods, as long as the patient remembers to take them every day.
Most pills include synthetic versions of both the hormones estrogen and progesterone and work by telling the patient’s brain not to make the ovary ovulate.
“They suppress ovulation, which lessens the chance of an egg being around to be fertilized,” Bowman said. “All of these are patient controlled. She puts it on or in and takes it off or out.”
Hormones may also be taken through a patch and a vaginal ring. The pill, patch and ring are all effective with a typical use failure rate of 7%.
“Very rarely, people starting the pill may have headaches or nausea, but that usually resolves after a few weeks,” Bowman said. “There’s a myth out there about weight gain on birth control pills, but that has been debunked.”
Injections and implants
Versions of progesterone can be injected or released through an under-the-skin implant. Injections have a typical use failure rate of 4% and last for three months, while the subdermal implant lasts for three years and has a typical use failure rate of only 0.01%. Side effects include irregular bleeding.
Similarly, an intrauterine device — or IUD — can be placed inside the woman’s uterus. It lasts for five to ten years and has a typical use failure rate of less than 1% of the time. Side effects include changes to bleeding that eventually resolve.
“The long-acting, reversible contraceptives are nice because the patient doesn’t have to think about it,” Bowman said. “They don’t have to take a pill, place a diaphragm or switch their ring. People love them. Their efficacy approaches sterilization, but you still have the option of changing your mind.”
In fact, Bowman’s top choice for almost anyone is an IUD, teens included. But for people who may not be comfortable with the idea of having something in their body, a birth control pill may be a better bet.
With hormonal birth control methods, a patient does not have to have regular menstruation if she doesn’t want to. And no birth control method is associated with future fertility issues.
If you experience side effects, be sure to follow up with your doctor.
“Sometimes, we don’t pick the right one at first,” Bowman said. “But they’re all reversible, and we can always change.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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