There are many ways to prevent pregnancy, and many choices that are available from your OB/gyn or primary care physician. I will review many of the options here. There is not a method that is 100% effective (besides abstinence!) so each woman should choose the method that is the most appealing to her and that will provide the most benefit to her. Women should weight the risks and benefits. Many of the options do more than just prevent pregnancy!

Long-Acting Reversible Contraceptives

In terms of greatest efficacy and the lowest chance of unplanned pregnancy, long acting reversible contraceptives (LARCs) are the best. These methods are greater than 99% effective, have a less than 1% chance of pregnancy.

Examples of LARC methods are the implant (Nexplanon, which is placed under the skin in your inner arm), and intrauterine device aka IUD (hormonal like Mirena, or non-hormonal Paraguard).
Although the LARC methods require a procedure, after that is completed, they are low maintenance because they do not require you to remember a daily pill or monthly shot etc.
LARCs are effective for 3 years (Nexplanon or Skyla IUD), 5 years (Mirena or Kyleena IUD), or 10 years (Paraguard IUD).
They can be removed when desired and they do not affect your fertility in the future or cause any delay in return to fertility. They are just as effective as sterilization, but reversible!
LARC methods can change your menstrual cycles in different ways.
- The Nexplanon may have no effect on your period. But it may cause the period to be lighter, irregular, or stop altogether. There are generally very low risks of other side effects.
- The hormonal IUD (Skyla, Kyleen, Mirena) also typically causes irregular periods initially but with time, periods become lighter and less painful. Most women will stop having periods.
- The non-hormonal IUD (Paraguard) can cause periods to become heavier and more painful especially during the first few months.
IUDs have a very small risk (< 1/1000 chance) of uterine perforation, where the IUD can poke through the wall of the uterus and into the abdomen. This requires surgical removal, but again, is very rare.

Image Credit: Mirena; https://www.mirena-us.com/about-mirena/ — Image Credit: Mirena; https://www.mirena-us.com/about-mirena/

Depo Provera

Depo provera is a birth control shot which is given once every 3 months. It contains the hormone progesterone. It is 94% effective.

It is a treatment which is also used for women with very heavy and painful periods or endometriosis.
Periods can be irregular initially, but they often become lighter, less painful, or completely stop.
Side effects include possible increase in appetite; if this causes increased caloric intake, weight gain may happen. However, if you maintain your normal eating and exercise habits, you should not have a problem with weight gain.
There is also a temporary loss of bone mineral density. This has not been shown to increase fracture risk as women age, and OB/gyns are not restricted in the amount of time that we prescribe depo provera. A healthy weight bearing exercise routine, calcium, and vitamin D, can help keep your bones strong.

Image Credit: http://www.women-info.com/en/depo-provera-contraception/ — Image Credit: http://www.women-info.com/en/depo-provera-contraception/

Combined Hormonal Contraceptives

These include birth control pills, birth control patch, and the vaginal ring. These methods require diligence to use them correctly and consistently. They have a 91% effectiveness.

This means that over 1 year with “typical use” there is about a 9% chance of unplanned pregnancy.
Women need to take the pill at the same time every day, replace the patch weekly, or the vaginal ring monthly.
These methods often decrease pain and amount of bleeding with periods. These methods can help regulate menstrual cycles when they are irregular or unpredictable.
Birth control pills can also improve acne, and decrease the chance of ovarian cancer in the future.
There are contraindications for some women who have medical problems that place them at increased risk (for example, 35 years old and smoking, history of blood clot, uncontrolled high blood pressure, less than 4 weeks from delivery of a baby, etc).

Image Credit: https://www.bedsider.org/features/89-which-birth-control-pill-is-right-for-me

Condoms

Condoms are the most accessible as they do not require a doctor’s appointment or prescription. They are 85% effective, so there is a higher chance of unplanned pregnancy when using this method.

They protect against sexually transmitted diseases, so are a great addition to the other methods above.
It is important that women use them correctly and consistently with every act of intercourse.

Image Credit; http://www.glamour.com/story/best-new-condoms-std-prevention — Image Credit; http://www.glamour.com/story/best-new-condoms-std-prevention

The Rhythm Method

Natural family planning is also known as the rhythm method. Effectiveness is about 75%.

With this birth control method the woman and her partner track her menstrual cycle as well as other body changes like cervical mucous to predict the times during her cycle when she is the most fertile.
Avoidance of this window of fertility provides contraception. It is not always effective because women’s cycles and time of ovulation can vary.

There are many choices when it comes to preventing pregnancy. Talk to your doctor about options, your medical history, current gynecologic concerns, and future family plans. I will write a follow up post specifically about IUDs next month as there is much more information to cover.

By Loriana Soma, M.D. - Expert Obstetrician/Gynecologist