The Doctor Is In: Which Birth Control Is Best For Me?

Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I am weighing my birth control options with my boyfriend. There are so many different choices now, so which is the least likely to fail? Any help would be appreciated!

A: In my opinion, the two reversible birth control options that are the most reliable are the Mirena IUD and Depo-Provera. Other hormonal contraceptives are also highly effective if used correctly.  Barrier methods, such as condoms and the diaphragm, are the least effective for pregnancy prevention.  To help you, I’ll go through each birth control method, one by one.

Barrier Methods
I’ve listed the barrier method options below, along with how effective they are. As you can see, in typical use, the failure rate is very high, but they’re cheap, safe, and non-hormonal. The downside, apart from the relatively high failure rate (and resulting unintended pregnancies) is that they’re messy, sometimes difficult to use, and a real pain in the rear. But because condoms are the only way to reduce your STD risk (note that I said REDUCE, not eliminate), it’s important to keep them on your radar.

Hormonal Methods

Oral contraceptive pills (OCPs) fall into this category, as does Ortho-Evra (the patch), Nuva-ring (the vaginal ring), and injectable contraceptives like Depo-Provera.  OCPs, Ortho-Evra and Nuva-ring are all just different delivery methods of basically the same hormones, which work by shutting off your own system and replacing your body with the hormones your own body would otherwise make in a way that inhibits ovulation (in addition to other mechanisms of action that I won’t get into here).  How are they different?  Ortho-Evra is a slightly higher dose and is available as a patch you can attach to your skin, which must be changed weekly. Nuva-ring is a vaginal ring you insert into the vagina (it’s easy to get in). Nuva-ring can stay in for 3 weeks, then you remove it to get a period. Nuva-ring seems to have fewer estrogen side effects than Ortho-Evra, in my experience.  Birth control pills come in all kinds of dosages and are easier to customize to the individual woman’s needs, but you must remember to take them every day.

Depo-Provera and Implanon are a bit of a different beast. While the others all contain a combination of low dose estrogen and progesterone, Depo-Provera and Implanon contain a very high dose of progesterone. Depo-Provera is an injection you get every three months, and because there is no estrogen, it can be used in women who cannot use other methods.  The down side is that it has a lot of side effects (irregular bleeding and weight gain are the biggest).  Frankly, I think Depo-Provera is great for teens who just can’t remember to use other methods correctly, but I’d never use it myself.  But that’s just me.  Some of my patients absolutely swear by it.

Implanon is an implantable form of birth control which is similar to Depo-Provera in its action and in the same family as the old Nor-Plant (but supposedly with fewer side effects). Since I have no personal experience with this contraceptive, I can’t comment on it further.

The advantage of these hormonal methods is they are all highly effective if you use them right.

IUD’s come in two types – the hormonal IUD (Mirena) and the non-hormonal Copper-T. I’ve been using Mirena for three years, and I LOVE it. Your gynecologist puts it in, and you’re good to go for 5 years (10 for the Copper-T).  The Mirena may have some breakthrough bleeding in the beginning, although because I put mine in when I was breast-feeding, I didn’t even have that. So I haven’t had a period in three years, which, frankly, is fine by me.

With the Copper T, you do continue to have menses, and they can be heavier and crampier because of the IUD. But some women love it because the Copper T contains absolutely no hormones.  Mirena does contain progesterone, which is released gradually and mostly acts locally on the uterine lining.  The advantage of the Mirena is that, over time, most women get very light or no menses, since the progesterone shrinks the uterine lining.  Both the Copper T and Mirena have an efficacy rate of >99%, making it a great alternative to tubal ligation.

Some gynecologists are reluctant to insert an IUD in a woman unless she is in a long-term monogamous relationship, because if a woman is at risk of STDs, the IUD may pose problems.  But if you’re interested, ask your gynecologist to help you assess whether you would be a good candidate.

Hope that helps!

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