Bridging the Gap - Health Equity for all

Birth Control: How to Pick the Perfect Protection for You

<blockquote> <h3>Fast Facts</h3> <ul> <li>When considering birth control options, there are a number of things you need to think about – from how it works, how effective it is, how long it lasts, the side effects, how it affects your libido, and much more.</li> <li>Broadly speaking, there are five and a half different types of birth control methods: abstinence, fertility awareness, hormonal, barrier, long-acting reversible, and sterilization. </li> <li>Fertility Awareness methods (FAMs) are the oldest forms of birth control and are also the least invasive because they don’t require you to ingest or insert anything. However, FAMs do require you to pay constant attention to your menstrual and ovulation cycles and be in tune with your body. </li> <li>Barrier methods mean you use something that goes into the body before sex to block sperm from getting into your uterus and fertilizing an egg.</li> </ul> </blockquote> Ah, babies. Sure, they’re adorable, cuddly, and precious, but that doesn’t necessarily mean you want one. Thankfully, there’s birth control. Nearly all women use some form of birth control at some point during their lifetime. In fact, based on statistics from the Centers for Disease Control and Prevention (CDC), the average American women loses her virginity at 16, has 1.6 kids, and hits menopause around 50 – barring problems with fertility, quick math tells us that the vast majority of women spend about three decades trying not to get pregnant. So, yes, thank you very much birth control! While many of us are lucky enough to live in a time when access to effective birth control is more widely available than ever before, the options to choose from are endless. There are hormonal birth control pills, patches, birth control shots, intrauterine devices (IUDs), and more. In fact, every time you watch tv or flip through a magazine, it seems there’s another new form of birth control on the market. With so many options available, it can be extremely hard to choose one. When you’re considering birth control options, there are a number of things you need to think about – from how it works, how effective it is, how long it lasts, the side effects, how it affects your libido, and much more. On top of that, not every birth control option is going to work for you. So, if you’re trying not to get pregnant, read on to learn more about the different methods of birth control and tips to help you think through your options and choose the one that is right for you. <figure><img src="https://cdn.storymd.com/optimized/rA32pkS4qM/thumbnail.jpg" alt width="640" height="360" /> <figcaption>Different Types of Contraceptives. Source: TheVisualMD</figcaption> </figure> <h2>Types of birth control </h2> It may be surprising to learn that birth control options haven’t radically changed since the 1960s, which was when both the intrauterine device (IUD) and the pill first became available. While both options are quite effective, and still available, there are more types now that work differently to choose from. Broadly speaking, there are five and a half different types of birth control methods: <h3>1. Abstinence Method</h3> This, of course, is the most effective form of birth control, sitting at 100% effective because no sex means no pregnancy. However, it’s also the least fun because it involves not having vaginal intercourse. The good news is that there are no side effects with this method – other than, the “no sex” part. <h3>2. Fertility Awareness Methods (FAMs)</h3> While FAMs can be used to help prevent pregnancy, they can also be used to help you become pregnant. They are the oldest forms of birth control and are also the least invasive because they don’t require you to ingest or insert anything. With that said, however, FAMs are also the least reliable birth control method because they require you to pay constant attention to your menstrual and ovulation cycles and be in tune with your body. It involves looking at your cervical mucus – colloquially known as vaginal discharge, which changes in consistency throughout your cycle: it’s thicker and whiter at the time of ovulation – and tracking your menstrual cycle on a calendar. Basal body temperature can also be used to track your fertile window during your menstrual cycle. If you have a regular cycle and you’re diligently paying close attention to your cycle, FAMs can be about 60% effective. However, it you have irregular periods, this method may not work for you. <h3>3. Barrier Methods</h3> These methods mean you use something that goes into the body before sex to block sperm from getting into your uterus and fertilizing an egg. Examples of barrier methods include: <ul> <li>Female condom. You were taught all about the male condom in sex ed class, but did you know that there’s a female condom? The female condom is inserted into the vagina up to eight hours before sex to help keep sperm from getting to an egg. Side effects are minimal; however, it is only about 75% to 95% effective at preventing pregnancy – so there is a risk. The upside is that the female condom may help prevent sexually transmitted infections (STIs). </li> <li>Spermicides. These are products that come in several different forms – gel, cream, suppository, film, tablet, or foam, and contain chemicals that kills sperm to prevent them from reaching an egg. Spermicides are inserted into the vagina no more than an hour before intercourse for maximum protection but can be left in place for up to eight hours afterwards. While spermicides can be used alone, they are only about 71% to 82% effective at preventing pregnancy, which is why it is usually recommended to use spermicides in addition to a male or female condom, diaphragm, or cervical cap to bump up protection. Spermicides do not prevent STIs. </li> <li>Diaphragm. This is a round, flexible rubber with a rigid rim that is inserted into the vagina to covers the cervix, thereby, blocking sperm from traveling to the uterus. Diaphragms can be inserted just prior to sex or up to six hours beforehand and it is reusable. Diaphragms are about 84% to 94% effective at preventing pregnancy and so, it is commonly recommended that spermicides are used alongside this method to help kill any sperm that makes it past the barrier. A diaphragm does not prevent STIs. </li> <li>Cervical cap. This is like the diaphragm’s little sister – it is used the same way, but it’s just smaller. It is also inserted into the vagina to fit over the cervix to keep sperm for entering the uterus and fertilizing an egg. It is also recommended to be used with spermicides for extra protection since it is only about 84% to 94% effective at preventing pregnancy. The cervical cap is also reusable and can be inserted right before sex and left inside your vagina for up to 24 hours without spermicide. Cervical caps do not prevent STIs. </li> <li>Sponge. Just like it sounds, the sponge is, well, a sponge. It is a small (about 2 inches in diameter), soft, round piece of plastic foam with a nylon loop attached to the bottom – for easy removal – that contains spermicide. The sponge is inserted into the vagina to cover the cervix to block sperm from entering. The level of effectiveness of the sponge varies – it is more effective for women who have not given birth before and less effective if you have had one or more vaginal births. A sponge does not prevent STIs.</li> </ul> <figure><img src="https://cdn.storymd.com/optimized/ELA1BPsQo5/thumbnail.jpg" alt width="640" height="360" /> <figcaption>Female Pelvis Showing Condom within Vagina. Source: TheVisualMD</figcaption> </figure> <h3>4. Hormonal methods </h3> <ul> <li>The Pill. This is the most common form of hormonal birth control, and it prevents pregnancy by tinkering with your hormones. Each tiny little pill contains a micro-dose of synthetic hormones – ethinyl estradiol and progestin or progestin-only, which is called a Minipill – that mimic estrogen and progesterone. By taking a pill every day, you are essentially supplementing your levels of estrogen and progesterone to suppress ovulation, thicken the cervical mucus to make it harder for sperm to get through, and thin the lining of the uterus. You are essentially tricking your body into thinking you’re already pregnant so that you can’t get pregnant. If you use the pill perfectly – meaning you take a pill at the same time every single day – it’s about 99% effective. But since most people aren’t perfectly on time every day, the actual effectiveness is close to 92%. The reason the pill is so popular is because common side effects are pretty mild: nausea, breast tenderness, and headaches – which usually subside after the first few months. If you happen to miss a pill, you might experience some breakthrough spotting. Another reason the pill is preferred is because it can help improve menstrual cramps, PMS, heavy bleeding, help regulate your cycle, and clear up acne. However, the pill does not prevent STIs. </li> <li>The Patch. Similar to the pill, the patch uses synthetic hormones as well. But unlike the pill, instead of taking a daily pill orally, the hormones are absorbed through a small patch that you stick on your skin once a week. Think of the patch like a super-sticky Band-Aid. Again, if the patch is used perfectly, the effectiveness is about 98%, but since it is highly likely that you will forget to change the patch at the same time every week, the effectiveness is close to 92%. Most of the side effects of the patch are the same as the pill; however, there are some more-concerning side effects to watch out for. The patch typically contains a higher dose of estrogen than the pill, which can up your risk of blood clots, heart attacks, stroke, and high blood pressure. And like the pill, the patch does not prevent STIs. </li> <li>The Ring. Like the pill and the patch, the ring contains synthetic hormones that mimic estrogen and progesterone, which get absorbed to block ovulation, thicken cervical mucus, and thin the uterine lining. The ring looks very much like a rubbery hair tie, and it is placed in the vagina once a month. If it is used perfectly as intended, the ring is about 99% effective. But if you forget to put the ring in on schedule, its effectiveness drops to about 91%. Side effects are similar to that of the pill and other hormonal methods, and like other hormonal methods, the ring does not prevent STIs. </li> <li>The Shot. Yup, you guessed it, the shot is an injectable birth control that contains synthetic hormones, which get slowly released into the bloodstream to suppress ovulation and trick your body into thinking you’re already pregnant. It’s usually given in the buttocks or the upper arm once every 12 weeks. If the shot is injected on schedule every three months, it is about 97% effective, according to the CDC. But since perfect timing doesn’t always happen, its effectiveness is closer to 91%. Like other hormonal birth control, side effects are minimal with some breast tenderness, headaches, and breakthrough bleeding if the shot is not given on time. The shot does not prevent STIs. </li> </ul> <h3>4.5. Long-Acting Reversible Methods (LARCs)</h3> <ul> <li>Intrauterine devices (IUDs) are long-acting reversible contraceptives (or LARCs) and can be considered a combination of barrier and hormonal methods. They are T-shaped devices that are inserted into the vagina and implanted directly inside your uterus (it’s a quick in-clinic procedure). They stay in place, acting as a physical barrier to prevent sperm from getting to your eggs. IUDs are more than 99% effective, immediately effective, and last anywhere from 3 to 10 years. If that wasn’t good enough, the best part is that the side effects are typically much lower than other types of birth control methods. IUDs do not prevent STIs. There are hormonal IUDs, which releases a small amount of hormone daily that thickens the cervical mucus and thins out the uterine lining – essentially making it nearly impossible for a sperm to reach an egg. The hormones may also stop your ovaries from releasing an egg in the first place. No egg means no pregnancy. Side effects of hormonal IUDs include light spotting, breast tenderness, or acne flare-ups at first. There are also non-hormonal IUDs where, instead of hormones, they use copper to cause a sterile, inflammatory reaction in the lining of the uterus, which makes it next to impossible for a sperm and egg to meet – thereby, preventing pregnancy. Side effects with non-hormonal IUDs include a change in your menstrual cycle – heavier, slightly longer, and crampier periods – in the first few months. </li> </ul> <ul> <li>Implants are technically a hormonal method, but they also fall in the same category as IUDs as they are LARCs. But instead of being implanted inside your uterus, this piece of plastic (about the size of a matchstick) is inserted under the skin of your upper arm and releases a small dose of hormone daily to suppress ovulation, thicken the cervical mucus, and thin the lining of the uterus. Like IUDs, implants are more than 99% effective and like other forms of hormonal birth control, side effects include breast tenderness, headaches, mood swings, decreased sex drive, and unpredictable bleeding or spotting. Implants also do no prevent STIs.</li> </ul> <figure><img src="https://cdn.storymd.com/optimized/YqGE1mT1ol/thumbnail.jpg" alt /> <figcaption>A Variety of IUDs. Source: LeiaWonder/Wikimedia</figcaption> </figure> <h3>5. Sterilization Methods </h3> If you don’t want to have any more children or none at all, this option is for you – meaning that this is a permanent method of birth control. These methods are more than 99% effective at preventing pregnancy and includes: <ul> <li>Tubal ligation (or tying tubes). Tubal ligation is a surgical procedure that involves having your fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. </li> <li>Transcervical sterilization. Transcervical sterilization involves using a thin tube to thread a tiny device into each fallopian tube, which irritates it and causes scar tissue to grow and permanently plug the tubes. </li> </ul> Both procedures do include some risks, such as damage to the bowels, bladder, major blood vessels, or a reaction to the anesthesia. And both do require a bit of down time, but once you’re fully recovered, both methods of birth control are immediately effective. All sterilization methods do not prevent STIs. <figure><img src="https://cdn.storymd.com/optimized/Ykqr7EFZAn/thumbnail.jpg" alt width="640" height="640" /> <figcaption>Tubal Ligation Showing Cut and Tied Fallopian Tube. Source: TheVisualMD</figcaption> </figure> <h2>How to find the best birth control for you</h2> Finding the right birth control for you is like finding the perfect bra: there’s going to be some trial and error, maybe some painful experiences, some may be a good fit for certain times of your life (think: your lifestyle in your early 20s vs 30s and strapless vs sports bra) – but finally, there will come a time (hopefully) that you find the perfect one that is just right – like Goldilocks! <h3>6 tips to help you choose the right birth control for you</h3> 1. Ask yourself questions. First, you must do your research and learn all about the different types of birth control methods available. Then start by asking yourself these questions: Do you feel comfortable using a method with a slightly higher failure rate? Do you feel strongly about being able to stop using a method whenever you want? Do you want to get pregnant soon or not at all? Do you want a birth control method that also prevents STIs? Does cost matter? Are you trying to manage other symptoms too? These are all important questions to keep in mind when choosing the right birth control. 2. Understand the side effects – negative and positive ones. While most women are able to tolerate the mild side effects of the pill and other hormonal methods, others experience severe headaches, mood swings, weight gain, low sex drive, and more, which may be less tolerable. It may take some trial and error for you to learn how your body will respond because not everyone is going to have the same experience. So, understand the potential side effects and determine which ones you are willing to tolerate. It’s also important to note that not all side effects are negative, and plenty of women choose birth control for non-sexual reasons, like better skin and lighter flow. 3. Fit it into your lifestyle. Ask yourself how the birth control method will fit into your lifestyle. If you can’t trust yourself to remember to take a pill at the same time every day, then the pill might not work for you. If you rather not have to think about it, then one of the longer-acting methods might be a better fit. Choose a birth control method that works for your lifestyle. 4. Consider your level of risk. Even if you’re using birth control, if you’re sexually active, there is always a small risk that you will become pregnant. With that said, there are some birth control methods that are more reliable than others. So, if you’re absolutely trying not to get pregnant, choose a method that is highly effective. Aside from the risk of pregnancy, there are other health risks too, depending on your health history. If you have a pre-existing medical condition, like heart disease, high blood pressure, or a history of blood clots, you may not be a candidate for certain methods, such as estrogen-containing birth control, which can exacerbate your condition. So, talk to your doctor who can help you determine your level of risk. 5. Don’t be afraid to experiment. Just because you started using a hormonal method in your early 20s doesn’t mean that you have to stick to that same method in your 30s or 40s. Different phases of your life may call for different types of birth control, so it’s totally fine to try a few different things to see how they work and make you feel. It’s all about trial and error because every woman’s body and preferences are different. If you’re not happy with your current method, talk to your doctor about other options. After all, there are plenty of birth control methods to choose from. 6. Talk to your doctor. Trying to choose the right birth control can be extremely overwhelming. But remember, you don’t have to figure it out all on your own – your doctor can certainly help. So, if you don’t know where to start and you’re set on not hearing the pitter patter of little feet anytime soon, let your doctor help you find the birth control method that’s best for you. <h2>More on Safer Sex and Contraception</h2><ul><li><a href="https://soulivity.storymd.com/journal/oja82r6h4w-contraception" target="_blank">Contraception (Birth Control): Types, Benefits, Risks</a></li><li><a href="https://soulivity.storymd.com/journal/wep6vx8t5j-oral-contraceptives" target="_blank">Birth Control Pill ("The Pill")</a></li><li><a href="https://soulivity.storymd.com/journal/jaqz6k6c4w-fertility-awareness-as-birth-control" target="_blank">Fertility Awareness-Based (FAB) Methods of Family Planning</a></li></ul>

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