Sex & fertility

Choosing birth control — options for women

by Marcy Holmes, Women’s Health NP

It amazes me how often my patients assume that when I ask them about contraception, I’m asking them about birth control pills. This confusion tells me how little so many women are taught about contraceptive options and how they work, since the Pill is just one of many forms of contraception. There are so many birth control methods available to women nowadays, from patches, to rings, to implanted uterine systems, that your form of contraception can evolve as your needs change.

As practitioners, we are pleased to have a plethora of choices to give to our patients. It means we can really work with a woman to find the best technique for her, thereby reducing adverse side effects and increasing her comfort level, satisfaction, and safety.

Women to Women’s approach to choosing birth control

I’d like to share with you the three-step approach to choosing a birth control method that I advise. It’s my hope that women and/or couples will use this information to choose the birth control method that meets their needs, and perhaps will be able to use it as a basis for discussion with their daughters — or sons. After all, birth control is not only a woman’s concern.

No birth control except abstinence is 100% fail-proof, and no barrier method is 100% effective against sexually transmitted diseases, but the more information you have and the better you understand where you are in your life, the easier it will be to find a method that works safely and effectively for you. This also applies to women in perimenopause who may have specific needs because of symptoms of hormonal imbalance, or because they have been on birth control pills for many years and want to discontinue hormonal contraception.

Preventing pregnancy

Initially, I always ask a woman to consider her birth control options in terms of just how important it is to her right now to NOT get pregnant. I also try to determine how successful she will be in using the method of her choice — no birth control will be effective if you forget to use it or use it incorrectly. These two questions help hone in on the methods that will most effectively support her goal in regards to preventing pregnancy.

For example, if a woman is desperate to not get pregnant (perhaps she’s in college and unmarried) but also sexually active, I would counsel a method that has the highest levels of success — even a combination of methods for optimal reassurance against both pregnancy and STD’s — like using birth control pills and condoms. If she’s in her late 30’s and is open to a potential pregnancy if it occurs, but would rather try to avoid having a child at this stage of her life, and wary of taking synthetic hormones, she may prefer another method even if it is slightly less effective than the Pill, like the diaphragm or the Sponge.

Birth control methods

Once we’ve talked about her individual requirements of a birth control method, I usually review the list of alternatives, beginning with the most effective options with perfect use — identifying also what non-perfect use does to reduce their effectiveness — down through the least effective options. I like to use a chart of contraception options with pictures and stats, and I also keep samples of a NuvaRing, IUD’s, Evra patch, and diaphragm handy to pull out in front of us to see and touch while we are talking.

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

For example, some women may have a strong family history of a blood-clotting disorder and carry a genetic mutation that places them at higher risk for a clot when using hormonal birth control. Other women experience an increase in blood pressure when using the Pill, and will usually switch to another method.

Birth control pills are not ideal for women who smoke, and most practitioners won’t prescribe them to smokers over the age of 35 because the risks really escalate at that point. If a woman weighs more than 180 pounds, the Pill may be less effective. In this case the ultra low-dose versions are especially not advisable.

Women with symptoms of depression or those who have been sensitive to hormones in the past might want to avoid longer-acting hormonal methods like the Depo-Provera shot.

Women with irregular cycles at any age find it hard to predict ovulation, so the rhythm method and its successors (basal body temperature, Billings method, etc.)  are usually not the wisest choices for them because they rely on the ability to accurately predict the days you are fertile.

Each woman should talk about her individual needs and health considerations with her doctor when choosing a birth control method. As always, we work from the inside out at Women to Women, within the framework of a patient’s whole health history.

Preferences for contraceptives

Thirdly, I always ask each woman to consider what birth control method appeals most to her. She should take into account her own satisfaction, convenience, side effects, fears, and in most cases, her partner’s cooperation and satisfaction.

Choosing the right birth control for you may take some time and a lot of thought. We use a comparison sheet that our patients take home to digest and/or discuss with their partners. Methods are listed by type and from most effective to least. While this list gives a broad range of options, it is not all-inclusive. We strongly encourage you to discuss these and other options with your practitioner before settling on one.

Sexually transmitted diseases and birth control

If you have more than one partner, start new relationships often, or suspect infidelity, any discussion of birth control needs to include a discussion on preventing sexually transmitted disease (STD’s).

Barrier methods like condoms are the best prevention from infections carried in semen, like HIV, but will not protect you from infections that can be transmitted by skin-to-skin contact, like herpes and HPV.

Most birth control methods, like the IUD or the Pill, are not sufficient in a situation of multiple or frequently changing partners because although they prevent pregnancy, they do not protect against STD’s. Adding a condom will provide better (though not complete) protection from infections.

Carrying condoms and handing them to a potential partner may feel a little awkward, but you should know you are worth it. If you stepped onto a boat knowing that there was a high probability that it might sink, I’m pretty sure you would bring 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?

Unfortunately, there are times when a woman in a monogamous relationship is the last to know that her partner has been unfaithful. As clinicians charged with protecting our patients’ health, it’s our job to be objective regarding fidelity, but hopefully your discussion with your doctor will be conducted in a sensitive and tactful manner.

When I bring this up with my married patients, I even tell them that I need to be objective because I don’t know their husband. I try not to discuss any concerns I have when they are in a vulnerable position, like in the middle of my examination. Every woman deserves eye-to-eye contact and to be in control when discussing her life and worries with her doctor.

We know that teens and women in their early 20’s seem at highest risk for many STD’s, but menopausal women are in one of the most rapidly escalating categories of new HIV infections. Remember also that only abstinence can eliminate risk. Safer sex is possible when you choose to reduce the number of exposures, use barriers, or choose monogamy with an uninfected partner.

What do you do to not get pregnant?

This rephrasing of the common question “What do you use for birth control?” often helps women to give a more accurate response than the frequent “Nothing” reply because she doesn’t use a hormonal method like the Pill. When I pose the question in this way, 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 difficult concept for some teens to grasp, but highly important.

It is essential to emphasize that what your partner does also counts. It is not all 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 with your partner, your doctor, and yourself. It may take a few visits to your practitioner’s office to finally decide what feels right 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 — i.e., 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).

How we eat, exercise, manage stress and take care of ourselves always matter. For example, 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 important for bone health, particularly if you are using the Depo-Provera shot, which is linked to a decrease in bone density. And women on the Pill need to supplement their intake of B vitamins, since birth control pills interfere with their absorption. We encourage all women — no matter what birth control method they choose — to take a pharmaceutical-grade multivitamin daily.

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

Related to this article:

References & further reading on birth control

 

Last Modified Date: 04/19/2011
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician