Over 100 million women across the globe take some form of birth control, yet many people don’t know how they work, or the many options available to them. Different forms of birth control can include: periods of abstinence, barrier contraception, hormonal methods, & non hormonal methods.
Navigating the world of contraception can be a tricky one, and with so many options out there, it is hard to decide which is the right one for YOU. If you are considering hormonal birth control, how do you know which one to choose? Are you aware of the risks and benefits associated with each?
Hormonal forms of contraception can include: the oral contraceptive pill (commonly known as “the pill” or OCP), Intrauterine devices (IUD), injectable contraception, the patch & the vaginal ring.
When deciding which form of contraception is right for YOU, it is important to be able to make an informed decision based on all available information.
How does hormonal contraception work?
Many hormonal contraceptives work on the basis of using hormones to prevent pregnancy. Depending on the specific hormones used, this can happen in a variety of different ways.
The “Pill”
All oral contraceptive pills should be taken at the SAME TIME EVERYDAY in order to ensure their maximal efficacy.There are TWO different types of oral contraceptive pills. One is the progestin ONLY pill (“mini pill”) which does not contain the hormone estrogen, and the other type is a combination pill which contains BOTH estrogen & progestin.
Mini Pills work to thicken the cervical mucous & thin the lining of the uterus, making it harder for the sperm to reach the egg. These pills can also work to prevent ovulation, and with no egg released for sperm to fertilize, pregnancy can not occur. Failure rates (unwanted pregnancy) with this pill are estimated at 7% within the first year of use.
Combination pills prevent pregnancy by inhibiting ovulation, thereby not allowing sperm to fertilize an egg. Failure rates with the combination pill range from 0.5%-5% with typical use.
The Hormonal IUD
Also known as an “intrauterine device”, the IUD can be a hormonal or non hormonal form of birth control. The hormonal version contains both estrogen and progestin and is one of the most effective contraceptive devices available, with failure rates less than 1%. These release hormones consistently & can stay in place for up to 5 years and can also result in a lighter period.
Contraceptive Patch
The patch contains both estrogen and progestin, & is placed on the skin where the hormones are directly absorbed. The patch is left on for 3 hormonal weeks, when it is then taken off for 1 week causing the withdrawal bleed of a menstrual period. Failure rates with the patch are estimated at 1 pregnancy per 100 women.
Contraceptive Vaginal Ring
A colourless flexible ring containing both estrogen and progestin is inserted into the vaginal canal where it stays in place for 3 weeks and is removed for 1 week, with a new ring inserted at the beginning of each cycle. The ring’s efficacy lies in its ability to completely suppress ovulation, preventing the ability of the egg to be fertilized. With proper use, less than 1 in 100 women will become pregnant on this form of contraception.
Injectables
Require muscular injections once every 3 months and consist of progestin ONLY. The hormones injected work by inhibiting ovulation for up to 15 weeks at a time. The failure rate with injectables is 0.3%.
What are the side effects?
The side effects depend on which hormones are present in the contraception. Most hormonal contraceptives contain a combination of both estrogen and progestin. In this case, the presence of both hormones can cause adverse effects including: nausea, breast tenderness, bleeding between periods, headaches & amenorrhea (loss of period). Some additional safety concerns of the addition of estrogen include the increased risk of a venous thrombosis (blood clot) especially in women who smoke or have pre-existing cardiovascular concerns. Additionally, those with high blood pressure should opt for the mini pill which is estrogen-free. Similarly, the mini pill may cause nausea, breast tenderness, headaches and amenorrhea, however does not increase the risk of clotting
So Which Is The Best Choice?
Well, that depends what you are looking for.
The patch and vaginal ring are both advantageous for reducing nausea and vomiting, since they do not require absorption through the gastrointestinal tract. However, the vaginal ring may cause vaginal irritation or discharge, may slip out during intercourse, & may cause irritation for the partner. Long term studies are not currently available for the vaginal ring since it is a newer form of contraception. The contraceptive patch may result in failure if it is not properly absorbed (which can occur in those women over 198 lbs), and may fall off during bathing.
The IUD is advantageous in it’s ability to stay in place for up to 5 years and has been shown to decrease the risk of both endometrial and ovarian cancers, however comes with an increased risk of uterine perforation at the time of insertion.
Injectable contraceptives, along with the mini pill, do not produce the serious adverse effects of estrogen. Injectables have also been shown to decrease the risks of endometrial and ovarian cancer, however it also decreases bone mineral density increasing fracture risk later in life
Note **** NO hormonal contraceptive methods will protect against the transmission of sexually transmitted infections***
Yours In Health
Dr. Laura, ND
References
- https://www.nichd.nih.gov/health/topics/contraception/conditioninfo/Pages/types.aspx#hormonal
- https://www.nichd.nih.gov/health/topics/contraception/conditioninfo/Pages/types.aspx#hormonal
- http://emedicine.medscape.com/article/258507-overview#a5
