Birth Control

Birth control is something many women use, but something few women completely understand. This is because there are many different options available, including pills, injections, topical patches, slow-release systems and others. Additionally, choosing which form to use and which dose is best depends on factors that are unique to your health and preferences.

When you schedule an appointment with our office to discuss your birth control needs, we’ll ask you to consider a few things while making a selection, such as:

  • Do you want to have children, and if you do, how soon?
  • Do you currently suffer from any health conditions?
  • How often do you engage in sexual activity?

We realize that choosing a birth control method is a highly personal decision, and we will provide you with the information you need to make an informed decision.

Cervical Cap

The cervical cap, also called a cervical cover (generic name) or FemCap (brand name), is a small, soft, cup-like device made out of silicone that fits around your cervix, the part of the uterus that opens into the upper part of the vagina. Suction keeps it in place, and it has a strap for easy removal. Used with spermicide, the cervical cap blocks sperm from entering the uterus. It comes in three sizes.

Advantages

  • Discreet (can be inserted prior to intercourse)
  • Easily reversible
  • Relatively low cost
  • After initial fitting, there is no need for return visits (unless size changes)

Disadvantages

  • No protection against STDs
  • Lower efficacy against pregnancy than other methods
  • Requires a prescription
  • Required with each act of sexual intercourse
  • May cause pain or discomfort
  • Increased risk of certain vaginal infections
  • Insertion and removal may be difficult

Diaphragm

The diaphragm is a thin, silicone dome filled with spermicide that fits over the opening to the cervix. It is one of the oldest forms of birth control.

Advantages

  • Discreet (can be inserted prior to intercourse)
  • Easily reversible
  • Relatively low cost
  • After initial fitting, there is no need for return visits (other than for replacement every two years)

Disadvantages

  • No protection against STDs
  • Lower efficacy against pregnancy than other methods
  • Required with each act of sexual intercourse
  • Increased risk of UTIs and vaginal infections
  • Insertion and removal may be difficult

Implant

The implant is a single, matchstick-sized rod that contains the progestin etonogestrel (the same progestin contained in the vaginal ring). There are two versions, Implanon and NEXPLANON (the second generation of this implant). Size, active medication, and side effect profile are unchanged from Implanon. The implant is effective for three years and is a good contraceptive choice for women who cannot use estrogen.

Advantages

  • Long-term solution, yet rapidly reversible
  • After removal, most women ovulate by three months, with the majority ovulating within three weeks
  • Highly effective
  • Rapid procedure: insertion takes one minute and removal takes three minutes
  • Can use while lactating (as soon as six weeks postpartum)

Disadvantages

  • No protection against STDs
  • Irregular bleeding
  • Requires visit to clinician for insertion and removal

IUD

The Intrauterine device (IUD) – also referred to as intrauterine contraception (IUC) or intrauterine system (IUS) – is a reversible contraception method that involves the placement of a small T-shaped device inside the uterus. There is a copper IUD (brand name ParaGard) and levonorgestrel IUDs (Mirena and Skyla). IUDs are a good choice for women who cannot use estrogen because they use either non-hormonal ingredients or progestin to prevent fertilization. They have one of the highest patient satisfaction rates among all contraceptives.

Advantages

  • Highly effective
  • Discreet
  • Long term
  • Discreet
  • Cost effective (after up-front cost)
  • Rapid return to fertility after removal

Disadvantages

  • No protection against STDs
  • Risk of expulsion within the first year
  • Requires visit to clinician for insertion and removal

NuvaRing

The NuvaRing is a flexible, transparent ring placed in the vagina. When inserted, the ring delivers a combination of hormones to inhibit ovulation. It comes in one size that fits most women; no fitting is required. The vaginal ring has one of the highest patient satisfaction rates.

Advantages

  • Convenient, once-a-month use
  • Excellent cycle control from the first month of use for most women
  • Does not require special fitting
  • Extra protection built in; if a woman forgets to remove the vaginal ring after 21 days, serum hormone levels will remain in the contraceptive range for up to one additional week
  • Potential for improved adherence

Disadvantages

  • Patient must remember to remove ring after three weeks, then insert another after a one-week break
  • May increase normal vaginal secretions
  • No protection against STDs

Patch

OrthoEvra is a beige-colored, transdermal contraceptive patch applied once a week to a part of a woman’s body, including the abdomen, buttock, upper outer arm, or upper torso (excluding breasts). The patch releases a combination of hormones. Three consecutive seven-day patches (21 days) are applied once a week, followed by one patch-free week per cycle. Although it is recommended that women put on a new patch after seven days, the patch contains up to nine days of contraceptive hormones.

Advantages

  • Extra protection built in; if a woman forgets to remove the patch after a week, serum hormone levels will remain in the contraceptive range for up to two additional days
  • Potential for improved adherence

Disadvantages

  • Concern about visibility of patch for some women (may be considered an advantage to others)
  • Possible skin reactions or detachment
  • Possible slight increase in risk of blood clots
  • No protection against STDs

Pill

The term “combined hormonal contraception” refers to methods that include both an estrogen and a progestin. In addition to protecting women from pregnancy, combined hormonal contraceptives have some non-contraceptive benefits, which include:

Menstrual-related health benefits, such as:

  • Decreased painful periods
  • Decreased menstrual blood loss and anemia
  • Possible reduction of premenstrual syndrome (PMS) symptoms

Other gynecological health benefits, such as decreased risk of:

  • Ectopic pregnancies
  • Endometrial and ovarian cancer
  • Benign breast conditions
  • Pelvic inflammatory disease (PID)

Non-gynecological benefit:

  • Effective in reducing acne

Advantages

  • Discreet
  • Very effective
  • Rapidly reversible
  • Easy to use, start and stop

Disadvantages

  • Requires a prescription
  • No protection against STDs

Shot

Depo-Provera® is a progestin-only method. It is a three-month injectable that inhibits ovulation. It is a good contraceptive choice for women who cannot use estrogen.

Advantages

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Lack of estrogen makes it appropriate for smokers older than age 35, postpartum breastfeeding women and others who have contraindications to estrogen
  • Reduces the risk of endometrial cancer by up to 80 percent, with continuing protection after discontinuation
  • Reduces risk of pelvic inflammatory disease and uterine fibroids
  • Can decrease the number and severity of crises in patients who have sickle cell anemia
  • Can decrease frequency of seizures and does not interact with anti-epileptic medications

Disadvantages

  • Requires visit to a clinician for the quarterly injection
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin
  • Short-term, reversible bone density loss
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods
  • No protection against STDs

Spermicide

Spermicides are creams, foams, gels, suppositories and films that contain a chemical lethal to sperm. They can be used alone or together with a barrier method.

Advantages

  • Over-the-counter availability
  • Easy to use
  • Easily reversible

Disadvantages

  • Lower effectiveness compared with most other contraceptive methods
  • Increased risk of vaginal irritation and infection with prolonged use
  • No protection against STDs

Sponge

The vaginal sponge is a small, circular, polyurethane sponge that contains spermicide. The sponge has a dimple on one side that fits over the cervix and a loop on the opposite side for removal. The vaginal sponge can be purchased at a pharmacy.

Advantages

  • Relatively discreet (can be inserted ahead of time)
  • Over-the-counter availability
  • Easily reversible

Disadvantages

  • Required with every act of intercourse
  • Lower success than some other methods with typical use
  • Increased risk of yeast infection and toxic shock syndrome if sponge is left in too long
  • No protection against STDs

Sterilization

When you have decided that you are finished having children, and hormonal birth control, barrier methods, IUDs and natural methods are too time-consuming or just don’t fit your lifestyle, A Woman’s View offers sterilization treatments as a possible permanent birth control option.

Our gynecologists are skilled at performing sterilization treatments that are safe, effective and permanent. If you would like more information, schedule a consultation. We will listen to your needs, and discuss your best options.

Non-Operative

Essure is the brand name of the tubal non-hormonal micro-insert used for permanent female sterilization. It is a soft, flexible insert consisting of two metal coils around a mesh of polyethylene terephthalate (PET) fibers, and it is delivered through the vagina and uterus, and permanently placed in each fallopian tube. Over time, a natural barrier forms, and prevents sperm from reaching the eggs. No incision is necessary to deliver or place the inserts, and general anesthesia is not necessary during the procedure.

Advantages

  • Highly effective
  • Long term
  • Discreet
  • Low risk of side effects
  • After up-front cost, no ongoing cost
  • No effect on hormones
  • No surgery required

Disadvantages

  • No protection against STDs
  • Requires visits to a clinician for insertion and follow-up
  • Limited data on effectiveness, risks and side effects

Operative

Surgical sterilization via tubal blockage has been a highly successful and safe method of birth control for many years. The fallopian tubes are blocked by tying them off, or using clips, rings or cauterization.

Advantages

  • Highly effective
  • Long term
  • Discreet
  • Low risk of side effects
  • After up-front cost, no ongoing cost
  • No effect on hormones
  • Immediately effective; no back-up contraception needed

Disadvantages

  • No protection against STDs
  • Requires surgical procedure