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Birth Control Choices

Elizabeth Stein, CNM (Midwife)

As women, we have choices! Birth control is not "one size fits all." There are several types of birth control: barrier, hormonal, surgical and rhythm. Barrier methods are condoms and diaphragms. They work by preventing the sperm from meeting the egg. Both are used at the time of sex. Used correctly, condoms and diaphragms prevent pregnancy only 85% of the time!!!

Another choice is hormonal. This includes the birth control pill (such as Ortho Tri Cyclen Lo, Estrostep and Ovcon), the patch (Ortho Evra Patch) and the vaginal ring (Nuvaring). All contain low doses of estrogen and progesterone that mimic the woman's own natural hormones. The pill, patch and the ring prevent ovulation, control the menstrual cycle, decrease bleeding, anemia, PMS, cramps and irritability. All three also reduce the chance of an ectopic pregnancy and PID (pelvic inflammatory disease). They are also used to treat ovarian cysts, polycystic ovaries and endometriosis. The good news is that they don't cause breast cancer and decrease the risk of ovarian and uterine cancer by 50% if used for 4 years!! (reason enough to consider using them!).

The birth control pills (there are more than 70 different ones on the market) are taken once a day for 28 days, the Patch is put on once a week for three weeks out of four, and the vaginal ring is left in the vagina for three weeks out of four. These are great options for a woman- once a day, once a week or once a month. Since these choices are not related to having sex, adherence is much better! Used properly, they prevent pregnancy 99% of the time. If you don't start the next cycle of pills (patch or ring) you will ovulate within 1-2 months. Pregnancy is then possible. They do not cause infertility.

The "morning after pill" must be used within 72 hours (3 days) of the "accident" such as the condom breaking or slipping off. It is actually 2 pills taken 12 hours apart. The sooner it is taken the more effective it is. The "morning after pill" is not a mystery pill-it is just a mega dose of the birth control pill! The "morning after pill" is emergency contraception, not birth control.

Not all women should use the pill, patch or the ring. Any woman with high blood pressure, cigarette smoker over 35, history of blood clots, Leiden V mutation, liver disease, severe migraines, undiagnosed genital bleeding or cancer should use another method of birth control.

Withdrawal and the rhythm method are not reliable enough to prevent pregnancy. Those couples who count on the withdrawal or rhythm method are usually called parents!

Depo Provera "the shot" is given once every three months. It contains only progesterone and has no estrogen. It is very effective (99%) but side effects can be a problem: irregular bleeding, weight gain and bone loss (reversible). It can also take a long time to wear off-as much as 1 ½-2 years which could be a problem if you want to get pregnant.

Another choice, available only to women that have already had at least one baby, is the IUD (intrauterine contraceptive device). This is a small sterile device covered with copper that is slipped inside the uterus and may stay there for up to 10 years. Because of the small risk of infection and then infertility blamed on the infection, it is not used in women without children.

Surgical methods of birth control are considered permanent. Men can have a vasectomy and women can have their "tubes cut" (bilateral tubal ligation/BTL). Although both procedures may be surgically reversed, there is no guarantee a pregnancy will result so this method should be chosen only by those who are very sure they will not want more children in the future.

Women are lucky to have many choices. None are perfect. All sexually active women should have their partner use a condom for germ control to prevent the risk of infection.

For a complete gynecological evaluation and birth control that is right for you, call for an appointment. Elizabeth Stein, CNM (Midwife) 212-685-3232

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