Nearly all women use birth control at some point in their lives, according to the National Center for Health Statistics at the Centers for Disease Control and Prevention. The Guttmacher Institute estimates that approximately 62 percent of women aged 15 to 44, around 43 million women, currently use contraception. Millions of men also use contraception and make birth control decisions jointly with their partners.
People have a wide range of birth control options available. They vary in terms of efficacy, side effects, time period during which they are effective, cost and more. The question of what birth control is best is not an easy one.
“Not all birth controls are the same, even with oral hormones. Some have higher estrogen, some have more androgenic progesterones, and so on,” explains Dr. Diana Atashroo, a gynecologist at NorthShore University HealthSystem, pointing out that “the pill” is not a singular option, but rather a group with many variations.
Moreover, it is difficult to make generalized recommendations — what is best cannot be considered by group but must be handled on an individual by individual basis, says Dr. Amy Whitaker, vice president and medical director, Planned Parenthood of Illinois, which saw 42,000 contraception visits in Fiscal Year 2016. Sixteen thousand of those visits were for birth control pills, with the remaining 26,000 visits for other kinds of contraception, including vasectomies. (Yes, Planned Parenthood offers contraceptive services for men, too.)
We asked experts to share how they recommend individuals choose the right method of birth control for them.
Know thyself
Understanding what works best for you is an important part of determining what birth control is right for you. Give some thought to your preferences in terms of schedule and commitment. Knowing what you are and are not comfortable with can help narrow your options.
Some women are great at taking a pill every day, others are not. There are women who prefer to not think about birth control on a daily basis. They may opt for an IUD or an implant, though some may cringe at the thought of a foreign object in their body. Another option is seeing their medical provider every three months for a Depo-Provera shot, but that’s not a good option for women looking to avoid excess doctor visits.
How a woman feels about her period can also play a role when choosing a birth control method. “It is not the case that you have to have a period every month. On continuous cycle birth control, you don’t have one and it is safe,” says Atashroo. She notes that some women love that option, whereas others are uncomfortable with the idea.
Condoms prevent sexually transmitted diseases and while in theory are very effective, Atashroo says that the efficacy rate is rather low due to user error. For people not in monogamous relationships, however, they should be used in addition to more reliable birth control.
Open up an ongoing conversation with your physician
Picking the right birth control method is not a drive-through event, and selecting the right option should be the result of collaboration between patient and physician.
“People should have an extensive conversation with their doctor and that should include the physician reviewing their medical history,” says Atashroo. She notes that individualizing treatment options based on age, history, risk factors and lifestyle can address potential problems early on. Be honest with your doctor about whether you smoke, which can increase risks with birth control.
Atashroo stresses the importance of follow-up. She likes to see patients three months after they have started a new form of birth control to address any side effects, which can include an increase in blood pressure.
“Sometimes finding the right contraceptive method is a matter of trial and error,” says Atashroo.
That conversation should be an ongoing one, too. Let your doctor know about changes in lifestyle. Different routines and big life events can mean that a contraception method that was working well is no longer the best option.
“What someone’s preference is at one point in their life may not be their preference later. Things change. Someone who uses birth control pills may get to a point where they find their life is too hectic and don’t want to think about a pill every day. Then they may switch to something requiring less intervention,” says Whitaker.
The impact of contraception on fertility
“A lot of patients think birth control will make them infertile if they are on it for a long time. That’s not the case at all,” says Atashroo.
The amount of time that it takes for a women to become pregnant, however, varies depending on the method.
“No birth control negatively impacts the ability of a woman to conceive, but the return to fertility varies,” Dr. Eve Feinberg, medical director of Northwestern Medicine Fertility and Reproductive Medicine. “Depo-Provera has a longer return to normal fertility, and it can take up to 18 months,” she explains, noting “You don’t have to be off birth control pills for months to get pregnant. They’re short lasting, which is why you have to take them every day.”
Women who have struggled with infertility should still consider birth control, depending on the reasons for the infertility. She notes that women who had trouble with ovulation should know that it often normalizes after pregnancy and that those who had unexplained infertility should also consider birth control if they are not looking to conceive. Feinberg also encourages her patients with PCOS to use birth control, noting that they can get pregnant even if doing so the first time was a struggle.
Consider side effects
Some women worry that extended time on hormonal birth control, particularly birth control pills, can increase their risk for cancer, but the experts agreed that the research has not shown a clear connection.
“In general, the data regarding birth control and developing breast cancer is limited. Most epidemiologic population studies don’t show an associative increase,” explains Dr. Atashroo. She adds, though, that if a woman has any history of breast cancer, she would encourage non-hormonal birth or copper IUD, and barrier methods like condoms and spermicides because “data on breast risks in oral contraceptive pill users with family history are also conflicting.”
A recent study out of Denmark published in JAMA Psychiatry found that women, especially among adolescents, who used hormone-based birth control were more likely to be prescribed an antidepressant or to be diagnosed with depression than women who did not use hormone-based birth control. The experts with whom we spoke, however, did not see that study as proving a clear link.
“Causation is not necessarily there with this study,” says Atashroo, noting that the study did not review changes in mood based on a validated scale. “But it does raise a valid point that mood changes are something to be considered and discussed, and it should be part of reviewing a patient’s history,” she says.
Whitaker agreed that changes in hormones can sometimes have effects on mood, but that there isn’t a clear-cut link. “The evidence is inconsistent,” she says, adding, “I prescribe based on the CDC criteria, which do not have contraindications for mood disorders.”
Not all side effects are bad, either. Some can be beneficial for women. “Birth control and contraceptive methods are named that because that is their primary purpose, but many have noncontraceptive health benefits as well. Many help control cycles, like estrogen-containing birth control pills. Progestin-containing IUDs have been shown to address heavy menstrual flows,” says Whitaker.
Using birth control pills for a prolonged period of time is associated with reduction of endometrial and ovarian cancer risks, according to the National Cancer Institute.
Sterilization
There are many stories, some of them quite humorous, of women who have recently given birth and announcing that their husbands will be getting a vasectomy. Before having the procedure, however, Feinberg says that it is a good idea for men to consider freezing sperm at a sperm bank, noting that she sees many patients who have had vasectomies and now wish to conceive a child, noting that IVF is the only way to have a baby.
While many think of vasectomies first when it comes to sterilization, female sterilization is more common than male sterilization. It is the second most commonly used birth control method in the United States since 1982, according to the Guttmacher Institute. There are several different options for female sterilization. Whitaker says women appreciate that the Essure procedure offered at Planned Parenthood does not require surgery or general anesthesia.
Atashroo says that in her office, most women opt for laparoscopic sterilization with removal of the fallopian tubes, an extra step that may reduce the risk of ovarian cancer.
Not everyone is convinced that sterilization is the best option. “Long-acting reversible contraception is so effective that I question why people would have permanent sterilization,” says Feinberg. “So many things happen in life — death, divorce, newfound love — and many decide they want another baby,” she adds.
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