Birth Control…Beyond the Pill: Understanding New Contraceptive Options

By Joshua Best, M.D., Bayou Regional Women’s Clinic
    We have certainly come a long way in society, culture, and women’s rights since 1960, when “the pill” was first approved by the U.S. Food and Drug Administration.  We have also made significant strides in medical science in the last 50 years.  However, I have found in my own practice that many patients are unaware of their contraceptive options. They are also getting misinformation from old wives tails, grandmas, moms, aunts, sisters, and even medical professionals.  
    Almost 50% of all pregnancies in the U.S. are unplanned; 80% of pregnancies in women under age 20 are unplanned.  These unplanned pregnancy numbers in our country are decreasing, thanks in large part to better access to contraception and wider acceptance of Long Acting Reversible Contraceptives (LARCs). “The pill” is the first thing that comes to mind when most people think of contraception, but the long acting contraceptives (IUDs, implants) are much more effective at preventing unplanned pregnancy. 
Contraceptive Options
    When I counsel my patients, I break down contraceptive options into two basic categories: short acting methods and long acting methods.  The short acting methods include the birth control pill, the patch, the vaginal ring, and the shot.  The long acting methods include three IUDs (one which contains copper and two which contain hormones) and the implant, Nexplanon.  
    The pill, the patch, and the ring contain two hormones, estrogen and progesterone.  The shot and the implant contain progesterone only.  In the IUDS, the hormone in Skyla and Mirena is progesterone, whereas Paragard is hormone free and contains only copper.  
    The pill is taken every day.  A patch is worn for a week at a time, for three weeks out of four.  The ring is placed in the vagina for three weeks out of four.  The shot is given once every 12 weeks.  
    The Nexplanon implant is inserted in the upper arm after the arm has been numbed with a local anesthetic. It provides contraception for three years. IUDS are placed through the cervix into the uterus.  Skyla IUD provides contraception for three years, Mirena IUD provides contraception for five years, and Paragard provides contraception for 10 years.  
Contraception Effectiveness
    No form of birth control is perfect. Every method of birth control has a failure rate. The failure rate reflects the number of unplanned pregnancies after one year of use, per 100 users.  That is to say, out of 100 women using this method of birth control, how many will be pregnant after one year of use?  
    Failure rates are also characterized with “typical use” and “perfect use”.  Short acting methods have “typical use” failure rates much higher than “perfect use” failure rates.  This is because the effectiveness of the short acting methods depends on the user: It’s easy to forget to take your pill. It’s easy to forget to fill your prescription.  “Typical use” and “perfect use” are the same for the long acting methods: once your birth control has been inserted, it is in place and working correctly.  
“Typical use” failure rates according to the U.S. Center for Disease Control (CDC): 
• Pill, Patch, Ring: 9% (approximately 1/11)
• Shot: 6% (approximately 1/17)
• Copper IUD: 0.8% (approximately 1/125)
• Tubal Sterilization: 0.5% (approximately 1/200)
• Hormone IUD: 0.2% (approximately 1/500)
• Implant: 0.05% (approximately 1/2000)
    The shot is 1.5 times as effective as the pill at preventing pregnancy.  An IUD is anywhere from 10-50 times more effective as the pill at preventing pregnancy and are as effective as being permanently sterilized.  The implant is almost 200 times more effective than the pill at preventing pregnancy and has a far lower failure rate than being permanently sterilized.  
    As noted, no form of birth control is perfect.  All forms of birth control are associated with side effects.  Common side effects include: 
• Irregular or unscheduled menstrual bleeding
• Nausea and or vomiting
• Headaches
• Mood changes
• Abdominal pain
• Certain types of birth control can be associated with less common, but more severe side effects or complications.   
    Different forms of birth control are appropriate for different patients.  All of the types of birth control have their own benefits, and they all have their own risks.  Please consult with your OB/GYN to discuss which type of birth control is right for you.  
    To schedule a woman’s wellness visit or prenatal care appointment with Dr. Best at either location in Zachary or Central, call Bayou Regional Women’s Clinic at (225) 658-1303.