Hoping to regulate your menstrual cycle? Know that kids are not in your immediate future? Whatever your reason is for choosing birth control, there are multiple forms from which to pick. No matter what method you decide on, it’s important to make an informed decision so you can select the option that best fits your lifestyle.

“When deciding what method of birth control to use, there are a few questions every woman needs to ask herself,” said Trisha Sheridan, clinical assistant professor at the Texas A&M Health Science Center College of Nursing and a certified Women’s Health Nurse Practitioner. “Can she remember to take a daily method; does she need or want a menstrual cycle; and does she smoke?”

Since there are so many options available to women, Sheridan offers the following rundown on each method:

The basics of hormonal methods

When looking at different forms of birth control, it is common to come across a wide variety of hormonal methods such as the pill, patch, injection, implant or IUDs. However, not all hormones are the same, and one form may be more conducive to your lifestyle than another.

There are two primary forms of hormonal birth control: progestin-only and a combination of estrogen and progesterone. Progestin-only methods work by thickening the mucus at the cervix and thinning the uterine lining, making it difficult for sperm to enter the uterus. Combination forms also work by changing cervical mucus and lining of the uterus, but they also prevent ovulation.

Methods with estrogen are not recommended for women over 35 who smoke, women who are nursing, or with a history or family history of developing blood clots.

Hormonal methods can be used to regulate menstrual cycles or to treat menses-related conditions such as painful cramping or premenstrual syndrome.

Common hormonal side effects are:

  • Moodiness
  • Weight change
  • Nausea
  • Acne
  • Headaches
  • Breast tenderness

While hormones can introduce uncomfortable side effects, most go away after a few months of use. If symptoms persist or worsen, contact your health care provider to see if another method might work better.

The pill

Perhaps the most common and widely known method of contraception is the daily pill. Within this category there are many different brands and forms that might impact a woman and her lifestyle differently.

“Birth control only works if you use it,” Sheridan commented. “So when you’re considering using some form of the pill, it’s important to consider whether or not you’ll remember to take it every day around the same time.”

Oral contraceptives are estimated to be 92 percent effective, taking into account typical use. Both combination and progestin-only pills are widely available, so it is easier to find a brand that works best for your lifestyle. The main differences between brands are the dosage of hormones and the different progestin or estrogen imitations they contain.

With oral contraceptives, women can choose to regulate their cycles to monthly, four times a year or to skip them altogether.

The patch

Hormonal patches are a weekly method of birth control that adhere to the skin and release estrogen and progestin into the blood stream. The patch is a small and easily concealable method. The patch contains a higher level of estrogen in it than a typical birth control pill, so it is not recommended for people who are predisposed towards forming blood clots, such as those who smoke or have a family history of clotting issues.

“Hormone-related side effects are frequently reported, especially breast tenderness,” Sheridan said.

The ring

A form of birth control that is gaining popularity is the vaginal ring. The ring is a monthly method that is inserted into the vagina for three weeks and removed for one.

With the ring, hormonal symptoms are less likely to occur, but users may experience vaginal discomfort or a change in the consistency of their discharge. For the most part, however, the ring shouldn’t be felt. Since the ring uses a combination of estrogen and progestin, it will regulate menstrual cycles, which will usually occur during the week it is removed.

Users are able to skip a period, if they choose, by inserting the ring immediately after removal of the previous one, but they should consult their physician before doing so. Like the oral contraceptive, the ring is dependent upon timing and with average use it is estimated to be 92 percent effective by the American Congress of Obstetricians and Gynecologists (ACOG).

The injection

The birth control shot is another form of contraceptive that lasts longer than oral contraceptives and is cited as having a 97 percent rate of effectiveness with typical use. Women who choose the shot receive a progestin injection from a health care provider every three months. Some women prefer this hormonal method, because it is more discreet and longer lasting.

“The first injection is usually administered within the first five days of the woman’s menstrual period and lasts for three months. After the second injection, most women stop having periods,” Sheridan said.

Women may experience a decrease in bone density while using the injections, but this effect is not permanent as bone density and hormone levels return to their normal state after injections are stopped. Some providers may recommend taking a calcium supplement, while taking the shot.

The implant

ACOG recommends long-acting, reversible contraception (LARC) methods as the primary form of birth control for most women. LARC methods are the most effective forms of birth control, and less than one in 100 women become pregnant during the first year of use. At any time during their effective periods, these methods are completely reversible.

The birth control implant is a LARC that lasts for up to three years. It is a matchstick-sized, flexible rod that is inserted under the skin of the upper arm. The procedure only takes a few minutes and a special inserter device is used so that no incision is made. For three years, the implant releases progestin into the blood stream. If the patient wants to remove the implant at any point during the three years, their health care provider can make a small incision to do so.

The hormonal IUDs

The longest-lasting and most effective forms of birth control are intrauterine devices (IUDs). IUDs are small T-shaped devices that are placed in the uterus during a regular gynecological visit and last for multiple years. The procedure only takes a few minutes and is easily removed during another office visit. There are multiple kinds of IUDs available: several hormonal ones and the copper IUD.

The hormonal IUDs are plastic devices that release progestin and are effective for up to five years. The Mirena IUD is approved by the Food and Drug Administration (FDA) to treat heavy or painful menstrual periods. Approximately 40 percent of users will cease having menstrual cycles after the first year of use; and most of the remainder experience lighter and shorter periods.

Aside from monthly self-checks, to ensure the device is in place and hasn’t moved, the IUD is a low-maintenance form of contraception. The devices have strings attached to the bottom, which contour to the vaginal walls. If the user feels that the strings have become misaligned, or if during the recommended monthly self-checks she can feel the device protruding from her uterus, she should schedule a visit with her health care practitioner.

The copper IUD

For women who want a long-term method of birth control, but aren’t too keen on hormonal methods, the copper IUD may be the preferred choice.

“The copper IUD is slightly less effective than its hormonal counterpart, due to its lack of progestin to thicken the cervical mucus, but pregnancies still occur in less than one woman out of 100,” Sheridan noted.

The copper works to repel any sperm that make their way into the uterus, creating a hostile environment for any foreign organisms. The copper device can last for up to 12 years after insertion. Since the copper IUD doesn’t utilize hormones, it doesn’t regulate periods and women will remain on their natural cycles.

IUDs are very effective forms of contraception, but not everyone should have them inserted. If women are susceptible to infections or have a pelvic inflammatory disease, they should not have an IUD placed. Any woman who has a sexually transmitted infection (STI) should seek treatment before having the device placed.

While pregnancies are rare with IUDs, when they do occur, ectopic pregnancies are more likely happen than with other methods. If a woman becomes pregnant with an IUD, they should meet with their health care provider to have the IUD removed.

Condoms

It’s a classic, yet important form of contraception that shouldn’t be disregarded: the condom – both for males and females. While all of the methods listed above are far more effective at preventing pregnancy and can help to regulate menstrual cycles, none of them can protect against STIs.

As opposed to hormonal and long-lasting methods of birth control, a prescription or visit to your health care provider is not necessary to obtain male and female condoms. However, both methods only offer around 80 percent effectiveness with typical use. If condoms are your preferred method of contraception, be sure to follow the directions on proper use.

From long range to short term, there are many different kinds of contraceptives that can fit your lifestyle. If you find yourself currently unhappy with your method of contraception, talk to your provider about different options. You have many alternatives at your disposal, but by asking a few key questions, you and your health care provider can determine which form of birth control fits your preferences and lifestyle best.

— Elizabeth Grimm

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