Choosing birth control—options for women

It shocks me how frequently, when I ask them about contraception,  patients assume I am asking about birth control pills. This confusion tells me how little the majority of women are taught about contraceptive options and how they work. The pill is just one of many different methods to prevent pregnancy. There are so many forms of birth control available to women nowadays, from patches, to rings, to implanted uterine systems, that the contraception you choose can evolve as your needs change throughout your lifetime.

Practitioners now have so many options to give to our patients. It means we can really work with you to find the best technique for your lifestyle, and for your sexual needs, thereby reducing unfavorable side effects and increasing your comfort level, satisfaction, and safety.

Marcelle’s approach to choosing birth control

Let’s look at an easy approach to choosing a birth control method that is right for you. It’s my hope that you and/or your partner will use this information to choose the birth control method that best meets your needs. Perhaps you will also then be able to use it as a basis for discussion with your daughters—or sons. After all, birth control is not only a woman’s concern.

No birth control except abstinence (not having any sexual intercourse) is 100 percent fail-proof and no barrier method (blocking the sperm from entering the uterus) is 100 percent effective against sexually transmitted diseases. However, the more information you have, the easier it will be to understand your options and find a method that works safely and efficiently for you. Women in perimenopause may have distinct requirements because of symptoms of hormonal imbalance, or because they have been on birth control pills for many years and would like to discontinue hormonal contraception. That’s why the stage of life you are in matters – as do a lot of other factors.  Let’s take a closer look.

Preventing pregnancy

Initially, I always ask a woman to consider her birth control options by thinking about just how important it is to her right now to NOT get pregnant. I also try to establish how motivated she might be in using the method of her choice—no birth control will be successful if she forgets to use it or if she uses it incorrectly. These two points help narrow the selection to methods that will most effectively support your goal in regard to preventing pregnancy.

For example, if a woman really does not want to get pregnant (perhaps she’s in school, or starting her career, or not married) but she does want to be sexually active, I would suggest a method that has the highest level of success—even a combination of methods for optimal reassurance against both pregnancy and sexually transmitted diseases (STDs) —such as using both birth control pills and condoms. From a different perspective, if she’s in her late 30’s and is not opposed to a potential pregnancy if it occurs, but would rather avoid becoming pregnant and having a baby at this stage of her life, and if she is also leery of taking synthetic hormones, she might use something other than the pill, even if it is slightly less effective, such as a diaphragm or a sponge.

Birth control methods

After we’ve discussed her personal preferences I usually review the list of options, beginning with the most effective if used correctly every time (also reviewing what happens if the method is not used correctly every time, which reduces it’s effectiveness) and progressing to the least effective options. I like to use visual aids of contraception options with pictures and information. I also keep samples of a NuvaRing, intrauterine device (IUD), Evra patch, and diaphragm available for us to see and touch while we are talking about it.

As we move through the list, I ask my patient to consider any age, health, or lifestyle habits that may make her a better candidate for some options and a poor candidate for others. Personal medical history, family medical history, weight, smoking, or having multiple partners are all major factors.

For example, some women could have a strong family history of a blood-clotting disorder and carry a genetic mutation that places them at greater danger for a clot when using hormonal birth control. Other women experience an increase in blood pressure when using the pill, and will usually choose to use another method.

Birth control pills are not ideal for smokers, and most practitioners won’t prescribe them to women who smoke if they are over the age of 35, because the risks increase greatly at that point. In addition, if a woman weighs more than 180 pounds, the pill may be less effective. In this case the extremely low-dose versions are specifically not advisable.

Most women with symptoms of depression or individuals who have already been sensitive to hormones in the past may want to steer clear of longer-acting hormonal approaches like the Depo-Provera. Women with irregular cycles at all ages uncover that it is difficult to predict ovulation, so the rhythm technique and its successors (basal physique temperature, Billings technique, etc.) are usually not the wisest selections for them simply because they depend on the ability to accurately predict the exact days they may be the most fertile.

When choosing the best method to prevent pregnancy, every woman should talk with her health care advisor about her personal needs and her health considerations. As always, we work from the inside out at the clinic, within the framework of your whole health history. We want to consider your lifestyle, your nutrition, your emotions, and give you the best information that will be essential for you to make your best choice.

Preferences for contraceptives

I always ask each woman to consider the method of contraception that appeals most to her, reminding her to consider and take into account her own fulfillment, satisfaction, convenience, ease of use, any side effects, and fears. In most cases, she should also consider her partner’s cooperation and satisfaction with the birth control method that she chooses.

Choosing the best birth control will take some time and a lot of thought. At the clinic, we use a comparison sheet that our patients take with them to process and/or discuss with their partners. The various methods are listed by type and from most effective to least effective. Although this list gives a wide range of choices, not every birth control method is included. We strongly encourage you to review and discuss these and other options with your health-care practitioner before deciding which method to use.

Sexually transmitted diseases and birth control

If you have more than one sexual partner, if you start new physical relationships often, or if you suspect your partner of infidelity (having a sexual relationship with someone else), any discussion of birth control needs to include a discussion about preventing STDs.

Barrier methods, such as condoms, are the best prevention from infections carried in the semen, such as the human immunodeficiency virus (HIV). Condoms will not, however, protect you from infections that can be transmitted by skin-to-skin contact, such as herpes and the human papillomavirus (HPV).

Most birth control methods, such as the IUD or the pill, are not adequate for those with multiple, or frequently changing, partners because although they prevent pregnancy, they do not protect against STDs. Using a condom does provide better (though not total) protection from infections.

Carrying condoms with you and handing them to a potential partner may feel a little awkward, but remember that you are worth it. It is important to be proactive to protect your health. If you were to get onboard a boat, knowing that there was a high likelihood that it would sink, I’m fairly certain that you would want a life preserver—no matter how awkward you felt wearing it. I really encourage women to empower themselves and feel this self-worth. After all, if you are going to have sex with someone, shouldn’t he care enough to wear a condom to protect you? If he puts up resistance, ask yourself, is he really worth it? In the long run it is not worth getting something that you will have to have for the rest of your life.

However, there are times when a woman in a monogamous relationship is the last to know that her companion has been unfaithful and sex with another person has not been revealed. As clinicians we are charged with protecting our patients’ health. It’s our job to be unbiased regarding fidelity, but hopefully your discussion with your practitioner will be conducted in a sensitive and tactful way.

Most people understand that teens and girls in their early 20s are at a higher risk for numerous STDs, but menopausal females are within the group with the most rapidly increasing rate of HIV infections. The best protection in contracting any STD is, not surprisingly, abstinence. The next best protection is condoms. But discussing previous sexual histories also can safeguard you even when in a monogamous partnership.

What do you do to not get pregnant?

Phrasing the question this way tends to get a more accurate answer than if I ask “What do you use for birth control?” because if she doesn’t use a hormonal method such as the pill, she will often answer nothing. When I pose the question what do you do to prevent yourself from getting pregnant I hear things like, “Oh—my husband had a vasectomy,” or “I have an IUD,” or “We use the calendar for timing and he pulls out.”

Of course, not having sex with men or abstaining from intercourse also prevents pregnancy for our celibate or lesbian patients. It is also a woman’s right to choose not to use birth control when having sex, as long as she acknowledges that this is a choice that frequently results in pregnancy. This is a complicated concept for some teens to grasp, but highly vital.

It is essential to emphasize that what your partner does about birth control also counts. It is not just the female in a relationship. We encourage you to try to have as open a dialogue about sex and birth control as you can between your partner, your medical doctor, and yourself. It might take several visits to your practitioner’s clinic to finally determine what feels suitable for you. But taking the time to learn about your options is the best way to find a method that will meet your needs.

A healthy lifestyle for adequate support

Many conventional doctors do not venture beyond the call-and-response format of an appointment when you go in to discuss birth control—that is, if you don’t ask, they don’t tell. But don’t forget that good health, nutrition, and lifestyle habits are important considerations for all women of childbearing age (and beyond).

The way we eat, exercise, handle stress and take proper care of ourselves always matters. For instance, if there is a chance you might get pregnant, getting adequate folic acid (400 mcg per day) is vital because a woman needs folic acid in her system at conception — weeks before she finds out she’s pregnant — to prevent birth defects. Calcium is significant for bone wellness, particularly if you are using the Depo-Provera shot, which is linked to lower levels in bone density. Females on the pill will want to supplement their intake of B vitamins, due to the fact that birth control pills interfere with their absorption. We encourage all women – regardless of what birth control strategy they choose – to take a pharmaceutical-grade multivitamin every day.

If you have questions about birth control methods, you may want to read our answers to commonly asked questions about birth control.