It can be truly overwhelming to figure out what is the best birth control plan for your body and life circumstances. This topic has been at the forefront of my conversations with so many patients because of changes that are coming about as a result of the recent overturning of Roe v. Wade.
I would like to give a brief summary here to help you start to sort out options for yourself so that you can have a more informed discussions with your health care provider about what will work best for you.
First, I want to say that there is no perfect birth control. It is highly dependent on individual factors like convenience, efficacy, and your specific health concerns.
Additionally, it’s a good idea to be prepared for what if scenarios. Especially if you live in a state that severely restricts your options. Every sexually active person that is not desiring pregnancy, should always have plan B on hand.
What types of birth control are available?
- Oral Contraceptives
- Patches and Nuva Ring
- IUDs— Non-Hormonal and Hormonal
- Condoms
- Fertility Awareness
- Vasectomy and Tubal Ligation
Pros and Cons of Oral Contraceptives
As a naturopathic doctor, oral contraceptive pills tend to not be my first choice for most of my patients. This is because I commonly see unwanted side effects, and it has the serious concern of coagulating blood, so for this reason, it is never advised to be used for people who are smokers, have a known health condition that coagulates their blood, or if they have ocular migraines. There is a correlation with higher incidence of cervical cancer.
On the plus side, oral contraceptives are generally well covered by insurance and therefore not expensive. There is also a lower incidence of colon cancer and ovarian cancer. They also tend to clear up acne pretty well.
They can be anywhere from 91% to 99% effective with perfect use, which is great. However, I have several patients who know that they have difficulty remembering to take something every single day so this would not be a good choice in that circumstance.
Pros and Cons of Birth Control Patches
Birth control patches are a form of contraception that is applied to the skin and releases hormones as it slowly dissolves. The hormones released by the patch prevent pregnancy by stopping ovulation or fertilization.
Because these patches eliminate the need for daily dosing and can be used for up to three months, they are a good option for women who want long-term contraception with a lower dose of hormones than pills or implants. They can also be worn discreetly under clothing, which makes them more popular than other forms of birth control.
However, a potential downside to birth control patches is that they are more expensive than birth control pills and might not be as effective as other forms of birth control in preventing pregnancy. The patch should also be applied at the same time each day, which can be difficult for people with busy schedules.
Pros and Cons of Nuva Rings
The Nuva Ring is a hormonal contraceptive that is inserted into the vagina. It releases hormones which stop ovulation, thicken cervical mucus and thin the lining of the uterus.
This can be a great choice for people taking androgen hormones as it reduced the frequency of periods and protects the uterus from developing a thick lining.
While the Nuva Ring is easier in some ways to take, it does require removing every 3 weeks, and unlike the pill, it can fall out with vigorous sexual activity or straining. It can also cause tissue irritation and vaginal discomfort. Similar to the pill, it does increase coagulability of blood. So it is not advised to use this type of contraceptive if there is smoking history, cardiovascular disease or a coagulation disorder.
Pros and Cons of IUDs
IUDs are T shaped devices that are inserted into uteruses for long term birth control action. They are widely considered to be the most effective type of birth control (except tubal ligation).
First, there is one type of non-hormonal IUD. This is the copper IUD called Paragard. It has no impact on a person’s hormones, because it works through its one simple ingredient, copper, to block sperm from reaching an egg. It is 99% effective and can last up to 10 years. It can be removed at any time and can be used during breastfeeding. Paragard is not a great choice for people who struggle with their periods, because it can increase blood flow and cramping. It is also not an option if the person has a fibroid or bleeding disorder that hasn’t been worked up or Wilson’s disease (an unusual disease of copper accumulation).
There are also hormonal IUDs that have progestin and last for varying amounts of time Skyla (3 years), Kyleena (5 years), Liletta (5 years) and Mirena (7 years). This type of IUD works by making cervical mucus too thick for sperm to reach an egg and uterine lining too thin for implantation. Many people enjoy the fact that periods usually become very light or sometimes nonexistent and cycle symptoms often improve. One study showed an 80% reduction in blood loss. This is great for people that struggle with iron deficiency and anemia. There are very, very rare incidences of serious health risks like uterine perforation, development of a PID and ectopic pregnancy. A more common risk is possible increased risk of depression and anxiety, though this is not an issue for everyone.
The downside for all IUDs is that insertion can range anywhere from being uncomfortable to downright painful. Once the IUD is settled, it should not cause any pain.
Pros and Cons of Fertility Awareness Methods
There are many methods in this category such as cervical mucus method, menstrual tracking method, basal body temperature method and sympto-thermal method AND abstaining/using condoms during fertile periods. While being informed of one’s cycle and symptoms, is useful knowledge, I would highly suggest that only people who are comfortable with the possibility of a pregnancy use this method. If you are comfortable with possibly getting pregnant, and other forms of birth control haven’t worked for you, and you are very committed to multiple types of tracking, this could be a good fit.
The typical success of this method is 76-88%. It is possible to achieve up to 99% success, but this relies on a high commitment level and stable cycles. Also, let’s be honest, people most want to have sex when they are fertile, so there is a serious need for serious barrier protection if you’re relying on FAM. The upside is that there are absolutely no side effects.
Pros and Cons of Tubal Ligation
The obvious upside is that this is a one-time procedure that provides life long, effective birth control. In my opinion, this has historically not been an option for so many people that would have jumped at the opportunity, and they had to prove that they were suffering beyond medication management to maybe be eligible. This isn’t right. The downside of this option is the possible cost and recovery time.
Pros and Cons of Condoms
I think that condoms don’t get enough respect. They are cheap, they are effective AND they protect from contracting STIs. Sometimes in these discussions, the very real risks of STIs are brushed under the carpet. The United States has some of the highest rates of STDs in the world. HPV, gonorrhea and chlamydia are the three most common. Condoms can be as effective as 99%, but slippage and breakage can lessen the effectiveness to 85% for preventing pregnancy. Another serious concern is whether the partner can be trusted to use a condom. Not everyone is in a healthy relationship, and it may be more prudent to take birth control into one’s own hands.
Clearly, there is no one size fits all approach to birth control. I highly recommend taking all the factors into account in order to find the right choice for you.