Today we’re talking about contraceptives, the different types, and which ones we recommend. Unfortunately, there aren’t a lot of great options. Most of them are on the woman to make a decision about what she wants to do with her body.
Some of the things that you want to think about before you choose a form of contraception are:
- Are you also in need of protection from sexually transmitted diseases? Because if you are also in need of that, then your options are much fewer.
- Is the relationship that you’re in monogamous?
- Do you trust your partner?
- How long have you been with your partner?
- Do they want to be a part of the decision-making process with you?
Above is a picture of all of the different types of contraception. Starting with the least effective: spermicides are not that effective; most women are sensitive to them; they can burn, they can cause irritation. It’ll often throw off the pH of the vagina, and then you’ll be more prone to getting vaginal infections, yeast infections, and urinary tract infections. There’s the withdrawal method, which we all know how effective that is.
And then, there are fertility awareness methods. These are pretty effective. The challenge with them is that they require extreme tracking and documentation from the woman to keep track of her periods, and she has to make sure that her cycles are normal and regular. Suppose she sometimes has a 21-day cycle, and sometimes her cycles are 28 days, and she’s fluctuating between shorter cycles and longer cycles. In that case, the fertility awareness methods are not that accurate, and she’s much more likely to get accidentally pregnant.
Then there are other barrier methods like the cervical cap, sponges, diaphragms, male condoms, and female condoms. I think if you’re going to bother using a female condom, you might as well use a male condom because they’re much easier and they’re cheaper to deal with.
Another method is the lactational amenorrhea method. This is when if a woman is nursing, then she hypothetically is not going to start ovulating again; however, this is not always the case. Many women will start their periods within a few months after having their child. So assuming that you are not going to get pregnant because you’re nursing is not a good form of contraception.
Moving into the hormonal options, we have pills. These are the conventional birth control pill options. Other hormonal options are the patch, which is put on the skin, and these are slowly releasing hormones into the skin. Then, there is the vaginal ring, which is placed inside vaginally, and that’s usually left in there for a few weeks. As well, there are hormonal injectables and implants.
And, of course, the non-reversible options like tube tying, which is female sterilization. This is when you have a tubal ligation. Or there’s a vasectomy, which is when the man has a snip of his tubes.
There’s also an IUD. An IUD is an insertion of a little plastic piece; it’s this little tiny T-shaped thing. There are a few different types of IUDs, some of them are hormonal, and there’s one that is non-hormonal called Paraguard.
Paraguard is my preference because this is one of the most effective forms of birth control that’s not hormonal. One of the problems with many hormonal contraceptives is that they’re non-bioidentical hormones, and non-bioidentical hormones can have hormonal consequences. There are estrogen and progesterone hormonal contraceptives, and then there’s progesterone-only contraceptives, but all of the hormones are non-bioidentical, which means that the hormones that the woman is taking are stronger than what our body naturally makes.
Dr. Watkins talked a lot about estrogen dominance in the previous articles. And when you’re taking a non-bioidentical estrogen, they’re much stronger than our natural production, and so the side effects of these hormonal contraceptives can get out of control. Often, women are put on hormonal contraception to treat something like painful periods or PCOS. PCOS is commonly treated with the birth control pill. The problem is that it’s not treating the hormonal disorder. It’s just a band-aid. Women are often put on hormonal contraceptives, and there was a hormonal disorder to start with that they never really addressed.
The hormone contraceptive is going to kind of band-aid and mask the underlying hormonal problem, but they’re still having hormone imbalance underneath. With PCOS, if the underlying hormonal problem is pre-diabetes, insulin resistance, or problems with blood sugar, then all those problems are going to continue to happen in the background. She’s probably going to gain weight on the pill; acne could be a problem. It’s going to be much more difficult for her to get pregnant later because when she stops the pill, those hormonal imbalances were never addressed.
So there’s not a lot of great options because we’ve got our condoms and sponges and in caps and diaphragms, which are all barrier methods, those can be irritating, they can throw off the pH, increasing the likelihood of getting an infection or a vaginal irritation, and then there are the hormonal options. So you can see why the IUD ends up being one that I do end up recommending.
One of the disadvantages to the IUD is that because it is a physical thing inside of you, irritating the lining of the tissue, one of the side effects is that it can make the periods heavier or more painful than they already were. So one of the times I don’t recommend an IUD is if you already have really severely painful periods or severely heavy periods because you might make those worse.
When you first have the IUD put in, the first period, I always warn women will be heavier because it’s the body having a shed cycle from this IUD just being inserted in there.
The second period after you have the IUD in is usually much lighter. And then the third period should represent what your subsequent periods will be moving forward on that IUD. And so that’s a good thing to know about that if you want a non-hormonal option, try the IUD and see how the period is, but give it three cycles. You want to see how you tolerate it after the third cycle.
Here’s a picture of these contraceptives and also a chart. Let me preface it with; I have not updated the efficacy percentages and the costs in some time. I have had this chart for many years, and I have not updated it, so please know that all of these prices are not up to date. But the advantages and disadvantages of each of these options are pretty up to date. So this is for you to reference, there’s the IUD there on the left, and there’s one of them that I mentioned called Paraguard, that’s the non-hormonal one, and there are some other IUDs too like Mirena and Skyla, there’s another one called Kylena, there are now some lower dose hormonal IUDs. My general opinion on a hormonal IUD is that if you’re going to go with hormonal birth control, you might just go with an oral contraceptive pill.
Now one thing to also know about these hormonal contraceptives is that they deplete your B vitamins. Whenever I put a patient on a birth control pill, which I do despite not liking them, I do still prescribe them when a patient decides this is the route they want to take. I educate them, I give them all of the options, and it’s their choice. So if they choose to go on the birth control pill, I make sure that they’re also on a good quality B complex because birth control pills deplete B vitamins.
I hope that this was helpful and informative. If you’d like a free 10-minute phone consult, where you can tell us a little bit about what’s going on with you and we can tell you what we think maybe our approach might be, or if we think we can help, call 480-588-6856.