When I ask my patients about contraception, they often assume I’m asking about birth control pills. The Pill is just one of many forms of contraception. Though women may be taught very little about their other options, there are many birth control methods available, from patches, to rings, to implanted uterine or other devices. This variety means that your form of contraception can evolve as your needs, or desires, change.

No birth control method — except abstinence — is 100% fail-proof and no barrier method is 100% effective against sexually transmitted diseases. The combination of good information and understanding where you are in life make it much easier to settle on a method that works safely and effectively for you. This also applies to women in perimenopause who may have specific needs because of hormonal imbalance symptoms, or because they have been on birth control pills for many years and want to discontinue hormonal contraception.

Preventing pregnancy

Initially, I always ask a woman to consider her birth control options based on how important it is to her right now to NOT get pregnant. I also try to determine how successful she will be in using the method she chooses since no birth control will be effective if you forget to use it or use it incorrectly. Your answers to these two questions will help you hone in on the methods that are right for you.

For example, if a woman is desperate to avoid pregnancy but is also sexually active, I would suggest a method with the highest levels of success. This is typically a combination of methods to protect against both pregnancy and STDs (sexually transmitted diseases) — like a progesterone-based implanted device and condoms. A woman may prefer another method such as a copper intrauterine device (IUD) or a diaphragm if she’s in her late 30’s and is open to a potential pregnancy but would rather avoid having a child now, and if she doesn’t want to take synthetic hormones.

Birth control methods

Once we’ve talked about a woman’s individual requirements for birth control, I review the list of alternatives, beginning with the options that are most effective — when used perfectly. I also identify how non-perfect use reduces their effectiveness. My list ends with the least effective options. I like to use a chart of contraception options with statistics, and offer samples of the NuvaRing, IUDs, Evra patch, and a diaphragm so the patient can see and touch them while we are talking.

As we move through the list, I ask a patient to consider age, health, or any lifestyle habits that may make certain options better than others. Personal medical history, family medical history, weight, smoking, and sexual history, like having multiple partners, are all major factors.

For example, some women with a strong family history of a blood-clotting disorder may carry a genetic mutation that places them at higher risk for a clot when using hormonal birth control. Other women may experience an increase in blood pressure when using the Pill, and will usually switch to another method.

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Birth control pills are not ideal for women who smoke, and most practitioners won’t prescribe them to smokers over the age of 35 because the risk of blood clots rises greatly at that age. Often the dosage of the Pill and some other hormonal devices are not strong enough for women who weigh more than 180 pounds. In these cases the ultra-low dose versions are not advised.

Women with symptoms of depression or those who have been sensitive to hormones in the past should avoid longer-acting hormonal methods like the Depo-Provera shot. Since women with irregular cycles at any age find it hard to predict ovulation, the rhythm method and similar techniques like using basal body temperature readings are not the best choices. These methods rely on being able to accurately predict the days you are fertile so you can avoid having sex during that period.

Each woman should talk about her individual needs and health considerations with her doctor when choosing a birth control method.

Preferences for contraceptives

It’s very important for each woman to consider which birth control method will appeal most to her. She should take into account her own satisfaction, convenience, side effects, fears, and in most cases, her partner’s cooperation and satisfaction.

Choosing the birth control that’s right for you may take time and a lot of thought and our comparison sheet can be helpful. Methods are listed by type, and from most effective to least, and though the list gives a broad range of options, it is not all-inclusive. We strongly encourage you to discuss these and other options with your practitioner before settling on one.

Sexually transmitted diseases and birth control

If you have more than one partner, start new relationships often, or suspect partner infidelity, your selection of birth control should include a discussion on preventing STDs.

Barrier methods, like condoms, are the best prevention from infections carried in semen, such as HIV (human immunodeficiency virus), but they won’t protect you from other infections that can be transmitted by skin-to-skin contact, like herpes and HPV (human papillomavirus).

Most birth control methods, like the IUD or the Pill, are not enough protection when a woman has multiple or frequently changing partners. Yes, these prevent pregnancy, but they do not protect against STDs. Adding a condom will provide better, though not complete, protection from infections.

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Carrying condoms with you and handing them to a potential partner may feel awkward, but you are worth a couple of uncomfortable moments. Keep in mind that you are essentially having intercourse with every sex partner your current partner has ever had before you — as well as all the partners those people had. After all, if you are going to have sex with a man, shouldn’t he care enough to wear a condom to protect you? If he puts up resistance, maybe you can ask yourself, is he really worth the risk?

Of course there are times when a woman who thinks she’s in a monogamous relationship is the last to know that her partner has been unfaithful. As clinicians who protect our patients’ health, it’s our job to be objective. Your discussion with a trusted doctor can cover this topic in a sensitive and tactful manner, and hopefully not during a physical examination. When I bring up infidelity with my married patients or those in long-term relationships, I tell them that I have to go over all possibilities because I don’t know their husbands.

While women in their teens and early 20’s seem at highest risk for many STDs, menopausal women are in one of the most rapidly-expanding categories for new HIV infections. Only abstinence can eliminate this risk completely. Know that safer sex is possible if you can reduce the number of exposures, use barrier methods, or choose monogamy with an uninfected partner.

What do you do to not get pregnant?

This rephrasing of the common question, “What do you use for birth control?” often helps women give a more accurate response. When I ask the question this way, I hear things like, “Oh — my husband had a vasectomy,” or “I have an IUD,” or “We use the calendar for timing.”

Of course abstaining from intercourse also prevents pregnancy. It is also every woman’s right to choose not to use birth control when having sex, though that decision frequently results in pregnancy. This is an especially important concept for teens to grasp.

What your partner does and wants also count. If at all possible, we encourage you to try to have an open dialogue about sex and birth control with your partner, your doctor — and yourself. It may take a while to finally decide what feels right for you but taking the time to learn about your options is the best way to find a method that will meet your needs.

A healthy lifestyle for support

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Regardless of your decision about birth control, good nutrition and a health-supporting lifestyle are the most important considerations for all women of childbearing age and beyond. The time limitations during appointments for those who practice modern medicine have led to a “call-and-response” approach to patient encounters: if you don’t ask, they don’t tell. How you eat, exercise, manage stress and take care of yourself always matters. For example, calcium is important for bone health and overall wellness, particularly if you are using the Depo-Provera shot, which has been linked to decreased bone density. Women on the Pill need to supplement their intake of B vitamins, since birth control pills interfere with absorption of these important nutrients.

We encourage all women to take a pharmaceutical-grade multivitamin daily and to treat themselves with care, both physically, and emotionally. With care and thought, you can make good birth control choices at every stage of life.

References

Jick, S., et al. 2006. Risk of nonfatal venous thromboembolism with oral contraceptives containing norgestimate or desogestrel compared to oral contraceptives containing levonorgestrel. Contraception, 73 (6), 566–570.

Jick, S., et al. 2006. Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception, 73 (3), 223–228.

Maine Center for Reproductive Health. May 2006. How dangerous is Ortho Evra? Newsletter.

Medscape.com. 2006. Should symptomatic menopausal women be offered hormone therapy? Medscape General Medicine, 8 (3), 40. URL: http://www.medscape.com/viewarticle/537095_4 (accessed 02.08.2007).

Winer, R., 2006. Condom use and the risk of genital human papillomavirus infection in young women. NEJM, 354 (25), 2645–2654. URL: http://content.nejm.org/cgi/content/abstract/354/25/2645 (accessed 02.19.2007; abstract only; subscription required for full access).

Additional resources for women

Our Bodies, Ourselves: A New Edition for a New Era, 2005 edition.

From the Boston’s Women’s Health Book Collective.

Women’s Bodies, Women’s Wisdom, by Christiane Northrup, MD.

CDC website for STDs:
http://www.cdc.gov/nchstp/dstd/disease_info.htm#GenInfo

Planned Parenthood website section on STDs:
http://www.plannedparenthood.org/sexual-health/stis-stds-101.htm

Planned Parenthood section on birth control options:
http://www.plannedparenthood.org/birth-control-pregnancy/birth-control-4211.htm