Contraceptives
There are many different methods of birth control and we offer the complete range of the current options. During your consultation, we will discuss the choices and help you select the method best suited to you.
Oral Contraceptives
Oral contraceptive pills (OCPs) are among the most commonly used forms of contraception. They combine estrogen and progesterone, which together prevent ovulation. When taken properly and without fail, they are over 99% effective in preventing pregnancies. There are other benefits to OCPs, including making your period more regular, lighter, and shorter and they help reduce menstrual cramps. There are also non-contraceptive uses for the pill, such as managing heavy bleeding and menstrual pain caused by fibroids and endometriosis. There are risks to OCPs, including a small risk of blood clots, heart attack, and stroke. The risk of these complications is higher in women over 35, smokers and in those with other cardiovascular risk factors such as high blood pressure and diabetes.
The Vaginal Ring
The vaginal ring is a flexible plastic device that is placed in the upper vagina. It releases estrogen and progesterone that is absorbed by the surrounding tissue. It is left in place for 21 days, removed for 7 days and then a new ring is placed.
The Skin Patch
Another means of delivering the contraceptive hormones is the patch, which is worn continuously on the skin and changed weekly during each month for 3 weeks, with the 4th week without the patch.
Birth Control Implant
This implant is a flexible rod that is inserted under the skin of the upper arm. It releases progestin into the body and protects against pregnancy for up to 3 years by stopping ovulation. While it is effective, side effects can occur in some women. The most common is unpredictable vaginal bleeding. Some women have heavier periods, some lighter- others lose their period entirely until the implant is removed.
Intra-Uterine Devices (IUDs)
IUDs are among the most reliable methods of birth control, as their use does not require you to remember to take a medication or to use a device- it is always in place. It is placed by the gynecologist in the office. There are two basic types, the hormone IUD, which can last up to 5 years and the non-hormone IUD, which can be used for up to 10 years.
There are some potential complications with their use, although serious complications are rare. First, it is possible for the IUD to come out of the uterus and if this occurs it will not prevent pregnancy. Rarely, the IUD can also perforate or puncture the wall of the uterus, and this occurs at a rate of about 1 in 1000 patients. IUDs may also predispose to infection of the uterus or fallopian tubes. If severe, this type of infection may interfere with future fertility. The risk is slightly elevated in the first 20 days after the IUD is inserted and overall the risk of an infection is about 1 in 100.
Barrier Methods of Birth Control
There are several barrier methods for contraception, including the diaphragm, the sponge, the cervical cap, male and female condoms, and spermicide. Although all these methods are effective, they are not as reliable as the oral contraceptives or the implantable devices. Pregnancy rates with these methods vary between 12 and 28%. The diaphragm and male condoms are somewhat more reliable than the other methods. Barrier methods have the advantage of being non-hormonal and they are easily placed or removed by the patient. Male and female condoms have the added benefit of reducing the risk of transmission of HIV and other sexually transmitted infections, although they do not offer complete protection.
Emergency Contraception
Emergency contraception is considered when a woman is raped, has had sex without use of a contraceptive, or if she thinks her method of contraception may have failed. This might be because several birth control pills were missed or a condom slipped off or broke. While emergency contraception may be appropriate in these instances, it is not as reliable as other regular birth control methods and this method is not recommended for ongoing use.
Emergency contraception that is progestin-only, such as Plan B, is available over the counter without a prescription. Pills that combine both estrogen and progesterone may also be used for emergency contraception, although they may not be as effective as progestin-only and they may cause nausea and vomiting. The progestin-only method is most effective when used within 72 hours of unprotected sex. We encourage patients to call to discuss their choices if they are in need of emergency contraception.
Sterilization
Many couples choose a permanent operative method for preventing pregnancy, with either tubal ligation (for women) or vasectomy (for men) the most commonly used procedures. Vasectomy for the male has advantages over tubal ligation, as it is a minor procedure that can be done in a urologist’s office. Tubal ligation is usually done using laparoscopy, which is done in an operating room with general anesthesia. Both are very effective means of permanently preventing pregnancy.