Contraception: More than the pill!

MARCH 7, 2013

Photo: Kathryn Schledwitz

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 topic will have four installments, so keep your eyes open for the next one!

Installment One: Combined Hormonal Methods

Combined hormonal methods include options containing both estrogen and progesterone – the pill, the patch and the ring. What do you need to know about this category?

  • Effectiveness: If used perfectly, up to 99% effective. In the real world, about 92% effective.
  • Each option has an increased risk of blood clots, high blood pressure, stroke, heart attack.
  • There is an increased breast cancer risk due to the estrogen in these methods.
  • These risks are higher if you are a smoker, and higher still if you are a smoker over age 35.
  • This may not be for you if you have high blood pressure, migraines, lupus, cancer, diabetes, high cholesterol.

I’ve broken this category down by dosing frequency. Are you forgetful? Don’t pick the everyday option!

Daily:  Combined estrogen-progestin pill

  • 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.

○       There are many different options as far as dosing of medication, so the amount of hormones can be tailored individually.

○      Many of them have acne benefits.

○      There is an option of taking continuously to get your period less frequently.

  • Cons: 

○      You have to remember to take it every day consistently for the best effectiveness.

○      The pill offers no STD protection, so condom use is still recommended.

Weekly: Ortho Evra transdermal patch

  • Pros: 

○      Easy to use! Place the patch on your skin (arm, buttocks or stomach) once weekly.

○      There is an option of taking continuously to get your period less frequently.

○      Does not require a procedure in the office.

  • Cons:

○      There is a risk of the patch falling off and instructions on what to do if this does occur. This includes using a backup method of contraception, such as a condom.

○      The patch only comes in one dose of hormones, which is on the higher end of the range offered with the pill.

○      The patch also offers no STD protection, so condom use is still encouraged.

○      Skin rashes rarely occur in some women.

○      Others may see it on your skin.

○      The patch is not as effective in women over 198 pounds.

○      As the patch has a slightly higher amount of estrogen in it, it may have a higher risk of blood clots than other combined methods.

Monthly: NuvaRing vaginal ring

  • Pros:

○      Easy to use! Place in the vagina monthly and remove once a month with your period.

○      There is an option of taking continuously to get your period less frequently.

○      Does not require a procedure in the office.

  • Cons:

○      Some women report increased discharge initially with use of the ring.

○      There is a risk of the ring falling out and instructions on what to do if this does occur. This includes using a backup method of contraception, such as a condom.

○       If you do not like using tampons, you may not like using the ring as it is inserted vaginally.

○      The ring also offers no STD protection, so condom use is still encouraged.

Stay tuned for Installment Two! I will go over progesterone-only contraceptive methods.

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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