Beyond the Pill
When it comes to birth control, new options abound.
By Donna Burch
Oral contraception is the No. 1 choice of birth control for American women.
But the pill isn’t the perfect fit for everyone. Certain women may not want to use oral contraception due to health concerns, unwanted side effects or because it’s hard to remember to take a pill every day.
For those women, there are plenty of effective and convenient alternatives to the pill.
Any woman who has discussed birth control options with her gynecologist lately has probably heard of the growing popularity of long-acting reversible contraception (LARC). The Centers for Disease Control and Prevention recently announced the usage of LARC methods, such as the IUD (intrauterine device) and the hormonal arm implant, has grown nearly five-fold over the past decade.
And that’s with good reason, say local gynecologists.
“The advantage of the IUD and the implant is that they are very easy for patients to manage,” says Dr. Frances Casey, director of family planning services at VCU Medical Center. “We refer to them as the ‘set it and forget it’ methods. Because they are placed [either in the uterus or arm] for you, they are highly effective. They are as effective as having your tubes tied.”
An IUD is a small, T-shaped device that is inserted into a woman’s uterus.
IUDs are extremely popular overseas, but haven’t caught on as well in the United States. That’s partially due to fears raised after thousands of women were harmed by the poorly designed Dalkon Shield during the 1970s. The Dalkon Shield was removed from the market after it was shown to cause dangerous pelvic infections.
IUDs have since been redesigned and are now considered to be a safe, viable birth control option for all women, regardless of age or whether they have previously given birth to children.
There are currently three IUD options for women.
The Mirena is the most popular and offers five years of protection from unwanted pregnancy. It works by releasing a small amount of progestin into the uterus. This thins the uterine lining and thickens cervical mucus, preventing sperm from reaching the egg.
The Skyla IUD works the same as the Mirena, but it’s smaller and is intended to be inserted into women who have not previously had children. The Skyla is effective for three years due to its size.
The third option is the Paragard, a copper, nonhormonal IUD that’s effective for up to 10 years. The copper creates a hostile environment in which sperm cannot survive.
All three IUDs provide long-term, highly effective (more than 99 percent) protection against unwanted pregnancy. Once the IUD is placed, no other maintenance is required, other than periodically checking to make sure the IUD’s insertion strings are still hanging from the cervix.
All three can be removed at any time, if a woman decides she wishes to become pregnant.
The Mirena and Skyla are known to decrease – and in some cases, stop – monthly periods.
“The majority of women will have no [menstrual] cycle with long-term Mirena use,” says Dr. Tova Lynn Burge from Manchester OB/GYN.
Paragard is a good option for women who have a personal or strong family history of breast cancer because it does not use hormones.
All three IUDs may initially cause irregular bleeding or spotting, but this usually stabilizes within a few months.
Some Paragard users report heavier than normal menstrual bleeding.
Insertion can be uncomfortable, particularly for women who have not given birth.
Other risks include expulsion, perforation of the uterus and a greater chance of ectopic pregnancy, although these are all rare.
Nexplanon hormonal implant
The Nexplanon is a small, flexible rod that’s placed under the skin in the upper arm. It releases progestin and is more than 99 percent effective against unwanted pregnancy for up to three years.
Nexplanon is very popular among teens and women in their 20s, says Dr. Shannon Brim from Virginia Physicians for Women.
The implant is a nice alternative to the IUD because it offers the same effectiveness but is not as invasive as inserting a device in the uterus.
The implant provides long-term, highly effective protection against unwanted pregnancy. Once Nexplanon is placed, no other maintenance is required until it’s removed.
The implant can be removed at any time if a woman decides she wants to become pregnant.
The implant is not quite as effective in overweight or obese women.
“The biggest side effect with that contraception is the irregularity in your menstrual period,” Burge says. “It can be infrequent, frequent or prolonged. A lot of women stop having cycles on it. Your cycle may be unpredictable.”
Other common side effects include acne, weight gain and headache.
Depo-Provera is a birth control shot that’s given every three months in the arm or buttocks. The shot is progestin-based and is more than 99 percent effective at preventing unwanted pregnancy.
Depo-Provera is effective at preventing pregnancy for up to three months.
“Weight gain is not uncommon,” says Dr. Andrew Moore from the Virginia Women’s Center.
It’s not unusual for women to gain 10-15 pounds during the first year of use.
Other possible side effects include irregular bleeding, breast tenderness and headache.
There’s some evidence that Depo-Provera may not be as effective in overweight or obese women.
The shot should not be used for more than two years in a row because it can cause bone loss. It may not be a good option for women with a history of osteoporosis.
Unlike an IUD or hormonal implant, the Depo-Provera is not removable. If a woman decides she wishes to become pregnant, then she must wait until the effects of the shot wear off.
Women must be committed to having an injection four times a year.
“If coming in every three months is hard to do, then we may need to consider something else that’s more long term,” Burge says.
Oral contraceptives have been a birth control mainstay for women since the 1960s, and that’s not likely to change anytime soon.
“I don’t think pills are going anywhere,” Brim says. “We use them for so many things,” other than just birth control.
Oral contraceptives are frequently prescribed to stabilize irregular or heavy periods and reduce menstrual symptoms.
But for busy women who are looking for a birth control option that doesn’t require popping a pill every day, long-acting reversible contraception methods, like the IUD, hormonal implant and birth control shot, offer effective, convenient alternatives.