Contraception: More than the Pill, Part 2.

FEBRUARY 5, 2014

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One of the top reasons that I see patients during their quarter life years is for contraception. My patients have the power to control how they will be planning their lives and families when it comes to pregnancy.   Lucky for us, we live in a world where there is so much more than just the pill! I love going through all the options, many of which are surprising and appealing given our busy lives.  This is the second of four installments, so look out for the next one soon! And check out the first post here:

PROGESTERONE ONLY METHODS

These methods have no estrogen and include the “mini-pill”, Depo-Provera, Implanon or Nexplanon, Mirena and Skyla. What’s important:

  • Each option has an increased risk of blood clots, high blood pressure, stroke, heart attack

  • These risks are higher if you are a smoker, and higher still if you are smoking and over age 35

  • This is a good method for migraine sufferers, especially those with aura

  • This is a great option if you want to breastfeed and still have pregnancy prevention

Just like for combined hormonal methods, I break this category down into how often a task must be completed.  Do you want long term birth control you don’t have to think about? Consider Nexplanon or Mirena!

Daily: Progestin-only pill (aka “mini-pill”)

  • Effectiveness:  if used perfectly, up to 97% effective. In the real world, about 92% effective.

  • Pros:

    • Easy to use! Take one pill at the same time every day. Medication is taken orally and can be done conveniently anywhere at any time.

    • Does not require a procedure in the office.

  • Cons:

    • You have to remember to take it every day AT THE SAME TIME daily consistently for the best effectiveness. It is much more time sensitive than the combined hormonal pill options.

    • The progesterone only pill offers no STD protection, so condom use is still recommended.

Quarterly: Depo-Provera (progestin) intramuscular injection

  • Effectiveness: In a perfect world, up to 99% effective. In the real world, about 97% effective

  • Pros:

    • You only need to do something four times per year!

    • Many women have fewer or lighter periods – and some women have no periods.

  • Cons:

    • Not for the needle phobic as this method requires an injection at your health care provider’s office four times a year.

    • There is a slight risk of weight gain with this method. Up to 5 pounds per year of use has been seen in some women.

    • Increased osteoporosis risk with long term use

    • Irregular periods and/or spotting are common with this method, especially in the first few months of use.

    • Depo offers no STD protection, so regular condom use is still encouraged

    • Consider alternative if you are interested in having a baby in the near future as it can take up to 18 months for the drug to completely clear from your body and for ovulation to occur regularly again.

Every three years: Implanon and Nexplanon subdermal rod

  • Effectiveness: in a perfect world AND in the real world greater than 99%

  • Pros:

    • This method is long acting and provides great effectiveness for up to three years!

    • It is quickly reversible after removal

    • Many women experience lighter periods. Some women have no periods with this method.

  • Cons:

    • This method requires a procedure for insertion and removal at your health care provider’s office. Local anesthesia is used.

    • Many women experience spotting and breakthrough bleeding while on this method

    • Implanon and Nexplanon offer no STD protection, so condom use is still encouraged.

Every three years: Skyla IUD (intrauterine device)

  • Effectiveness: in a perfect world AND in the real world greater than 99%

  • Pros:

    • This method is long acting and provides great effectiveness for up to three years!

    • It is quickly reversible after removal

    • Many women experience lighter periods

    • This device is smaller than Mirena and can often used if a patient is not a candidate for a Mirena

  • Cons:

    • This method requires a procedure for insertion and removal at your health care provider’s office

    • Most women experience spotting and breakthrough bleeding while on this method

    • Skyla offers no STD protection, so condom use is still encouraged.

Every five years: Mirena IUD (intrauterine device)

  • Effectiveness: In a perfect world AND in the real world greater than 99% effective

  • Pros:

    • This method is long acting and provides great effectiveness for up to 5 years!

    • It is quickly reversible after removal

    • Most women experience lighter periods. Some women have no periods at all with this method.

  • Cons:

    • This method requires a procedure for insertion and removal at your health care provider’s office.

    • It offers no STD protection, so condom use is still encouraged.

    • Many women experience spotting and breakthrough bleeding, especially in the first few months after insertion.

  • Myth: you do NOT have to have had a pregnancy or vaginal delivery to have this type of contraception

 

Stay tuned for Installment Three! I will go over nonhormonal contraceptive methods.

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Dr. Sarah J. Wistreich is a staff physician at the Center for Women’s Health at Capital Health located in Hamilton, NJ. You can follow her on Twitter: @DrWistreich

All information contained herein is the opinion and view of the writer. It is intended to provide helpful and informative material on the subjects addressed and is not meant to malign any company, organization, religion, ethnic group, or individual. Readers should consult their personal physicians or specialists before adopting any of the recommendations or drawing inference from information contained herein. The writer specifically disclaims all responsibility for any liability, loss, risk — personal or otherwise — incurred as a consequence, directly or indirectly, from the use and application of any material provided.

Please note: This information was current as of its post date. But medical information is always changing, and some information given here may be out of date. Please see your physician for the most up to date information.

 

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