How to choose the right birth control

In writing this article, I should state that I am NOT a medical doctor, medical student, nurse or anyone else in the medical profession. I have, however, done extensive personal and professional research on all forms of birth control. Additionally, I have used every form of birth control mentioned here and will make my best effort to give details on each form of birth control I have used. I will also attempt to give information on forms of birth control I have not used in a separate section at the bottom of this article. I am writing this with the intended audience of women so if there are any men reading this, please excuse me, for I understand that men reading about birth control are doing so in an attempt to assist their sexual partner and do not wished to be grossed out by the particulars of the female reproductive system.

Let's nix the myths

One concern for many women is the effectiveness of their contraceptive method. There are many rumors about effectiveness, horror stories of women who get pregnant while on antibiotics, after a tubal ligation, after skipping only ONE pill and so on. Before getting into all the particulars of each method, let's get rid of the myths.

1. If you use the birth control method AS DIRECTED ON THE PACKAGE INSERT, you will have the same chance of preventing pregnancy as listed in the insert. For example, if the birth control pill you are using says it is 99.8% effective, it will be IF AND ONLY IF you are taking the pills as prescribed. Otherwise, the efficacy CAN decrease.

2. MOST forms of hormonal birth control are NOT abortifacients (they do not cause abortions). What this means is that the first course of action is to prevent an egg from being released by the ovary, through hormonal means. Secondly, the hormones cause an increase in cervical mucus, hindering sperm from entering the fallopian tube and fertilizing the egg. The third way hormonal methods prevent pregnancy is to thin the lining of the uterus, preventing implantation of a fertilized egg (in the rare event the woman continues to ovulate and the man's sperm passes through the thickened cervical mucus)

**small biology lesson**

After fertilization in the fallopian tube, the fertilized egg travels down into the uterus and implants in the uterine wall. This is called implantation. Not every egg that is fertilized will implant into the uterus and, even in a woman who is not on birth control, an implanted egg may not stay, resulting in an early miscarriage.

The only reason I say MOST hormonal forms of birth control are not abortifacients is because there ARE women who ovulate and CAN have a fertilized egg that does not implant into the uterus. Some people are uncomfortable with this and consider it a preemptive abortion.

3. Birth control will NOT make you gain weight. Period. NO explanation necessary. Do the research.

What types are there? What's right for me?

There are many types of contraceptives. I personally have used the patch, the pill, the ring, the shot, condoms, and the hormonal IUD. Many women are uncomfortable with the idea of putting something "down there" (in their vagina) and some other women are also uncomfortable with having something "stuck in you", such as an IUD or Nuvaring.

The first thing you need to do when considering what form of birth control is right for you is to understand the requirements for each form of birth control, what fits in with your schedule, and what you are comfortable doing (or not doing) when it comes to your body. Remember, this is YOUR body. It does not belong to your partner. If you are not comfortable with needles, do NOT get the shot! If you know you are not likely to remember to take the pill every day, do NOT get the pill! Your partner may be more comfortable with you being on a certain form of birth control but this is ultimately YOUR decision, as YOU will be the one to handle this on a regular basis.

The types that will be discussed here (that I have used) are:

Condoms, NuvaRing (ring), Depo Provera (shot), Ortho Evra (patch), The Pill (various) and Mirena (IUD)

Barrier Methods

The condom is what I refer to as "the virgin's birth control", meaning that this is something a woman will generally use when she is not sexually active on a regular basis. Unfortunately, this is one of the less effective methods compared to hormonal birth control methods. While condoms are about 80-85% effective (a far cry better than the "withdrawal" method - or as I like to call it "Pull and pray"), they are much more effective at preventing sexually transmitted diseases than pregnancy. I am not discounting the value of condoms. They are GREAT for women who are sensitive to hormones, for those unplanned encounters when you are not on a consistent method of birth control, or for women who wish to be cautious when considering potential diseases. I will caution, though, that I do not think condoms should be used as a long term method of birth control. I did not mention it previously but I have also used contraceptive foams and films and do recommend their use in addition to condoms if this is the only long term method that is feasible for you.

Hormonal methods I have used

All forms of hormonal birth control have roughly the same efficacy rates when used as directed - approximately 99%. Another thing women should know is that all hormonal forms of birth control CAN cause intermittent spotting (pink tinted discharge) or light bleeding.

The Pill (there are many types - this refers to combined oral contraceptives that have both an estrogen and progestin component)

The Pill was the first approved form of hormonal birth control and has been around for about 50 years. There are many types, from Seasonale, where you take about 90 hormonal pills and only menstruate a few times a year, to the "regular" pill where you take hormonal pills for 21 days a month with a 7 day break, to YAZ and LoEstrin, where you take hormonal pills for 24 days with a 3 day break. There are many benefits to each of these and the benefits can range from a decrease in what is commonly referred to as "PMS symptoms" to a reduction in acne, and to something called menorrhagia, which is excessive bleeding during menstruation. Deciding on the correct pill for you is a discussion you will have to have with your healthcare provider.

Some things to consider when choosing the pill are your ability to take a pill AT THE SAME TIME EVERY SINGLE DAY, your willingness to refill the prescription every month and your wish to menstruate. Some women do not wish to have a period and may choose either a different pill, to take it continuously (without a break) or to choose a different birth control method. I, personally, will not refill a prescription every month. It just won't happen. Couple that with my inability to take a pill at the same time every day and the fact that I don't want a period, the pill is definitely NOT for me.

NuvaRing (aka "the ring")

NuvaRing is a great option for those of us who will not take a pill every day due to laziness or circumstance. The positives to this are that you insert it into your vagina once a month and remove it three weeks later. You allow for a one week break without the ring and then insert another ring at the end of that week. You can take this method continuously (it won't harm you in any way), you will just have to pay for more than 12 packs in a year and have an additional prescription from your healthcare professional.

I had issues with this method because I am sensitive to hormones and it made me feel a little "off" emotionally when I took it for a long period of time. Other than that, I LOVED it! Again, I will not fill a prescription every month, so this was not a good long term option for me. Some women have issues with inserting something into their vagina. Other women are paranoid that it will fall out. Some women who may be concerned that it will fall out will not wish to check to see if it is still located in the vagina, so that could be a deterrent. I have heard personal accounts from friends stating that the ring got "placed" on their partner's penis during intercourse, although neither of them noticed it until after the fact. I have not heard any stories of a man feeling the ring during sex, although I am sure it happens on occasion. It can cost a little more than the pill but may be worth it for many women.

Depo Provera (the shot)The shot is another great method for women who will not take a pill every day. You go to a healthcare provider once every 3 months for the shot and that is all! Unfortunately, it may be very inconvenient to do this. For me, I also had to stop at a pharmacy to pick up the vial of medicine before bringing it to my midwife for administration. Retail is about $90, which is cheaper than a 3 month supply of brand name birth control pills or the ring. Obviously, if you do not like needles, this is NOT for you. The injection is usually in the hip/buttocks.

Ortho Evra (the patch)The patch is placed on the skin once a week for three weeks, with a one week break per month. I had some issues with the patch, personally. It itched when it stayed on, often came off, and made me feel nauseated the first day I put it on for the month. Additionally, I was technically over the weight limit for suggested use of the patch. At the time (shortly after the birth of my second child), I was weighing in at 200 lbs. The recommended weight is under 198 lbs. There have been some lawsuits regarding blood clots as a result of the patch and many clinicians are hesitant to prescribe it. One thing should be mentioned in regard to blood clots. The risk of blood clots DURING PREGNANCY is far greater than the risk of blood clots from using hormonal birth control. ANY birth control is safer than pregnancy when it comes to blood clots. It is up to you to determine what risks you want to take. Again, I won't fill a prescription once a month but for those who will, this may be a great option for you. I had several friends who used it and none of them had the problems I had - nor did they have any blood clots.

Mirena (IUD)The Mirena is my all time favorite birth control method. The reason why is because I didn't have to get a prescription filled or worry about putting it on, what week is it, did I take a pill that day, etc... for FIVE YEARS. I was VERY hesitant to get this IUD, because I didn't want something in me. After doing the research, I realized that this was the most feasible option for ME. I am not trying to sell it but I really did love it. My periods stopped while using it (I had excessive bleeding and was anemic at one point, so that was AWESOME!) and I didn't have to worry about getting pregnant. Some of my friends got IUDs after I got the Mirena. Some of them got the Mirena, some got ParaGard (non-hormonal, copper IUD) and they have all been satisfied with it. It can be expensive depending on your insurance but you can also get it free through the Arch Foundation, if you qualify. Actually, many pharmaceuticals can be received at a discounted price if you contact the manufacturer. There are drawbacks, such as having to have an office visit to get it put in AND taken out, your partner MAY feel the strings during sex and, rarely, it can move. This can be determined by feeling for the strings yourself by inserting your fingers into your vagina. Again, this may be uncomfortable for many women and may prohibit the use of this method.

Methods I have NOT used

I have not used Implanon or Norplant. Both of these are implants placed into the skin. Norplant is no longer on the market in the USA and while I know Implanon was approved by the FDA in 2003, I am not sure it is prescribed in the USA (likely due to lawsuits from Norplant). My understanding from my Canadian friends is that it's great.

The ParaGard IUD is another form I have not used and it is not hormonal. ParaGard uses copper to prevent pregnancy, and may not be suitable for people with certain allergies. People I know who have it love it. It's good for 7 years.

Cervical Cap, Diaphragm and other similar barrier methods - I know almost nothing about these except that they use a contraceptive jelly and you need to be fitted for a cervical cap. They are good for people who cannot use hormones but are about as effective as a condom when used correctly.

I know this is very long but I hope it is useful to you! Good luck choosing your birth control method!