Birth control pills primarily help prevent ovulation for women. They also change the cervical mucus, making it harder for the egg and the sperm to come together.
There have been changes over time and the dose has decreased significantly. The pills available nowadays may have only one fifteenth the amount of hormone that they had when pills were initially introduced. It definitely confers less risk, certainly less side effects.
The minipill is a progesterone-only pill. Technically, it’s not quite as effective at preventing pregnancy as the regular combined pill that has the estrogen and the progesterone, but it works well for certain people. It’s very commonly used among people who are postpartum and breastfeeding.
The failure rate for the combined birth control pills is on the order of 4 percent. About 80 percent of women would manage to get pregnant in a given year if they weren’t using anything at all.
The mini pill would be for people who have issues with hypertension, migraines with auras, people who have increased risk of
having heart attacks or people who have a personal history of blood clots that are formed inside their body.
The injectable form of progesterone lasts three months. Typically the dosing is every 12 weeks. People can get it between every 10 and 13 weeks. It’s very effective. It doesn’t require anything on the part of the patient to ensure that it’s working for them. They just have to remember to come to their appointments. This particular form of contraception is probably more effective than taking birth control pills.
One of the side effects is that it commonly will lead to irregular bleeding or changes in people’s menstrual bleeding. Also, the injectable form has a tendency to have a longer echo after people have stopped using it because it takes a while for it to be cleared from their body. So, for folks who are hoping to become pregnant shortly after they discontinued birth control, that may not be the best choice.
The birth control patch has been around for a while. That patch is really convenient because you don’t have to remember to take a pill every day. You just place the patch on your skin for three weeks in a row, then take it off for the week when you have your period. There is some concern that the overall dosing with hormones is higher with the patch and that may lead to increased risk of certain problems like blood cots.
The patch is about an inch and a quarter in size. You rotate the location once a week. You can put it anywhere on your body other than your breast. You can put it on your arm, on your belly, on your back and on your thighs.
The implantable form of progesterone is a highly effective form of contraception. It is a long-acting reversible contraceptive. It’s good for three years.
It’s very popular among young women. It doesn’t require any maintenance. For most people, it’s very, very minimal discomfort putting it in. They put it in and they forget about it for the next three years.
It’s a little bit bigger than a quarter. It could go on the underside of a person’s arm, usually in their non-dominant arm, between their elbow and their underarm.
The IUD [intrauterine contraceptive device] is among my favorite forms of contraception for my patients. The copper IUD is among the largest of the IUDs. The IUD is extremely effective at preventing pregnancy. It is also a long-acting reversible form of contraception. The [copper] IUD is good for 10 years.
It is for people who are looking for contraception that is essentially maintenance-free. It’s compatible with breastfeeding. This is a great choice for essentially all people who don’t have a copper allergy.
The IUDs that don’t have hormones set up a sterile inflammation of the uterine lining. It leads to extremely effective contraception. The failure rate is a fraction of 1 percent. That IUD has a tendency initially to give people heavier menstrual periods.
The progesterone-containing IUDs, which constantly diffuse a little bit of hormone to affect the uterine cavity, have a tendency to give people much lighter menstrual periods.
The vaginal ring is another one of my favorite forms of contraception for my patients. It’s placed vaginally and the hormones are slowly absorbed through the walls of the vagina. Typically, you put it in for 21 days and take it out for seven days during a menstrual period that occurs every 28 days. People don’t have to remember to take a pill everyday. They basically just put the ring in once a month. It also gives low exposure to hormone dosing.
The ring is small and flexible. Generally speaking, people just have to be willing to touch themselves. In my experience, people who have used oral forms of birth control and then switch to the ring almost never switch back because the dosing is so easy.
Everything has its advantages and everything has its disadvantages. Condoms are great, not only because they give you the benefit of the contraception, but they also help prevent sexually transmitted infections.
They are user-dependent. You need to be experienced and understand how to put on a condom. A condom always has to be put on before there is any contact. It’s important to understand how to do that correctly.
There are people who use condoms their entire life and they never have any contraceptive failures. Condoms can break. They can fall off. They have to be used correctly. Technically, the efficacy when you look at populations at large is not as high as with other forms of contraception.
For people who have regular periods, there is a certain window in their cycle when they’re at their peak of their fertility. That can help people who are trying to get pregnant, and it can help people who are not trying to get pregnant.
I recommend my patients who are hoping to become pregnant or hoping to not become pregnant that they track their periods using any one of a number of smartphone apps. Some actually send people push notifications to let them know when they’re at the peak of their fertility.
It’s difficult to know for sure about risks. There are a couple of things that have definitely been demonstrated over time. Strangely and interestingly, women actually have a decreased risk of having uterine and ovarian cancer if they’ve been on hormonal contraception for at least a decade. As far as breast cancer, most studies would suggest that there is not an increased risk, but if there is, it seems to decrease rapidly once the hormones have been discontinued.
Part of that is talking with your partner and understanding their personal history. I would argue that it makes sense to use condoms every time until you find yourself in a monogamous situation.
Cervical cancer is caused by a sexually transmitted virus, the human papillomavirus. Certain subtypes of the HPV can cause cancerous changes on a woman’s cervix. The vaccine is for both men and women because men are the transmitters of the virus and so, it’s an excellent idea for people to be vaccinated. The FDA recently increased the age of vaccinations between people, all the way up to age of 45. The FDA approved the earliest age for vaccination to be nine years old. Typically, women will get it before they become sexually active. It’s routinely offered by pediatricians around the ages of 11 and 12 to both boys and girls.
There are options for both men and women for sterilization. For women, there is a surgery that you can do where you interrupt a person’s Fallopian tubes. For men, they can get a vasectomy. The tubal sterilization or tubal interruption procedure is something that’s done in the operating room. A vasectomy is typically done in a doctor’s office.
It’s designed to be permanent. In certain instances, it can be reversible, though honestly, that doesn’t work so well for a lot people. I think when you’re thinking about permanent contraception, you would want ask if you’re sure that you want to do this, largely because there is still the availability of highly effective, but reversible forms of contraception like the IUD.
The choices that people make does depend largely on their age. For example, using IUDs is really common for folks who have had children, are not sure if they’re going to have anymore children, but are looking for a long-acting reversible form of contraception before they make their final decision.
Certain contraceptives are associated with increased risks as people age, specifically the ones that use systemic hormones. The risk of patients having problems with blood clots, possibly heart problems, increases as women age.
It depends on the person’s situation, what their beliefs are, what their values are and what their plans for future pregnancies are if they even have them.
You want to take into consideration, not only how effective the various options people have are, but also what their own desires are, what their own reproductive plan is.
Watch the San Diego Health video on birth control options featuring Dr. Dunn.