Deciding on a method for pregnancy prevention can be an overwhelming task. Internal medical physician, Kimberlee Tomerlin, DO answers popular questions women have about birth control methods.
Q. When considering pregnancy prevention there are many different options available. Where do I start?
Dr. Tomerlin: Your best resource for any medical information is always your healthcare provider. They can provide information on the different methods available as well as answer questions to help you decide which options will best suit you.
It’s also a great idea to research your options before your appointment. This way you’ll be able to ask informed questions. One helpful interactive tool is the Association of Reproductive Health Professionals MethodMatch.
Three major areas you should consider when choosing a birth control method are reversibility, effectiveness, and how it will fit in with your lifestyle.
Q. What should I take into consideration when deciding on contraceptives?
Dr. Tomerlin: First, you should evaluate your plans for any future pregnancies. If your family is complete, you may consider permanent birth control. These methods include female sterilization (tubal ligation) or vasectomy for males. While both may be reversible, they are meant to be permanent, and may encounter difficulties when attempting reversal. The procedures to reverse permanent birth control are also very costly and are not covered by insurance.
Effectiveness is also another aspect of birth control you should consider. The most effective methods are abstinence, tubal ligation, vasectomy, and IUD (intrauterine device). Slightly less effective options are oral birth control pills, injection (Depo-Provera), patch, and vaginal ring. Diaphragm, female condom, male condom, and withdrawal can be effective methods if used properly. Lastly, emergency contraception, spermicide, and fertility awareness methods are also moderately effective at preventing pregnancy.
Your lifestyle also plays a prominent role in choosing the ideal method of birth control. If your life is hectic with constant changes to your daily schedule, you may not want to choose a method that requires you use or take routinely. Also, you may not be interested in methods that require preparation before sex. If you are not in a monogamous relationship, you may want a method that will also protect against sexually transmitted diseases.
Q. What health risk factors should I consider when choosing a birth control method?
Dr. Tomerlin: Most birth control methods prevent pregnancy by regulating hormones. There are certain health conditions where hormone therapy is harmful.
Patients with a known blood clotting disorder or women who are over 35 years old and smoke, should avoid hormone therapy (i.e. any hormonal birth control method) as this increases their risk of developing a blood clot. Some clots can be life-threatening, such as clots in the lungs. Women with a known clotting disorder may opt for a non-hormonal IUD (i.e. copper, like Paragard). These are patients with a history of high blood pressure, diabetes, or patients on anti-seizure medications.
Also, women with a history of an estrogen-dependent tumor (breast or uterine) should not use hormonal birth control methods. It is best to speak with your healthcare provider before taking birth control if you have concerns about your health.
Q. Additional Risk Factors - There are some women who may take hormonal birth control but will need close monitoring.
Dr. Tomerlin: Women with a history of migraine headache with visual or other neurologic symptoms (e.g. aura) should not take oral birth control pills as this may increase their risk of seizures.
Oral birth control pills can cause an elevation in blood pressure, which is why it is important to monitor blood pressure in women with a history of hypertension. If an increase in blood pressure is noted, it is possible to switch to a progestin only (mini pill) method. Progestin is a hormone similar to the naturally produced progesterone. Progestin only pills are just as effective as combination pills (estrogen plus progestin) when taken at the same time every day. If the pill timing varies more than three hours, patients should use a backup method to prevent pregnancy.
Women with diabetes who are taking insulin may need to increase their insulin dose once they start birth control. It is important to monitor blood sugars when starting new medications and to discuss medication doses with your regular health care provider. Diabetic women who have vascular complications from diabetes should not use hormonal birth control.
Seizure medications can decrease the efficiency of hormonal birth control by affecting the way the drugs are metabolized.
Q. What is the best birth control method for helping with painful periods?
Dr. Tomerlin: Painful cramping with periods, known as dysmenorrhea, can be alleviated with use of oral birth control pills. Most all birth control methods will help relieve pain but birth control pills have been shown to have the greatest affect.
Q. What about heavy bleeding with periods?
Dr. Tomerlin: Mirena is an IUD (intrauterine device) that has been proven to help with heavy menstrual bleeding. IUD's are inserted by healthcare professionals in the office setting. The Mirena IUD can be in place for up to five years. Once removed, most patients are able to get pregnant immediately.
Q. What are some common side effects of birth control methods?
Dr. Tomerlin: Side effects can vary between methods. Some of the most common side effects are breast tenderness, headache, skin changes (i.e. acne), moodiness, and increased blood pressure. Not all women will experience these side effects. In fact, some women have these symptoms at baseline and actually notice improvement in their symptoms with birth control use.
For more information on birth control methods, schedule an appointment to speak with a healthcare provider.