Birth Control Methods

Pregnancy prevention is a very important part of a woman’s health. The only birth control method that has 100% guarantee to prevent pregnancy is abstinence, or not having vaginal sex. An added benefit of abstinence is it decreases your risk of acquiring a sexually transmitted disease. If abstinence is not a desirable option for you and you desire to postpone pregnancy, there are many birth control options available today that you can choose from including short-term, long-term and permanent birth control methods that are available with and without hormones. Discuss these options with your healthcare provider to decide which method is the best for you.

Short Term Birth Control Options

Barrier Contraceptives
The short-term, non-hormonal (no hormone medications), barrier contraceptives include condoms, diaphragms, and cervical caps. Spermicides are commonly used with these methods, but it is not advised to just use spermicide alone. Condoms are the only form of contraception that help protect against sexually transmitted diseases (STDs). All of these methods are the least effective at preventing pregnancy, less convenient for most women, and they do not give patients the benefits from hormonal therapy such as lighter periods, decreased cramping and protection from uterine and ovarian cancer. But they also do not have the risks associated with hormonal therapies.

Natural Family Planning
Another possible short-term or long-term, non-hormonal birth control method is called Natural Family Planning (NFP). This method has multiple different practice options, but generally they are all based on the timing of sex during a woman’s menstrual cycle. NFP is also called periodic abstinence. It is safe and low cost and can be an effective way to prevent pregnancy if the method is used correctly at all times. The success or failure of this depends on the couple’s ability to recognize the signs that ovulation (the release of the egg from the woman’s ovary) is about to occur, as well as the couple’s ability to not have sex or wear condoms during the fertile period, which is the time when the woman can get pregnant. This can be more than two weeks per month. Thus a woman must know her body well. The various methods may include testing daily temperatures, assessing daily vaginal discharge/cervical mucus, using an ovulation prediction monitor and/or keeping a menstrual diary. Sex becomes limited and a lot less spontaneous. As a result some couples find this method very hard to use. Other couples, however, find that this method improves their communication, since it takes effort on both their parts to make this method work effectively. Plus NFP doesn’t have the potential side effects of hormonal contraception. Even with perfect use, a woman has a risk of pregnancy. Statistics show on average 25% of women who use this method become pregnant. NFP does not protect against STDs nor have the potential benefits of hormonal therapy. This method is not advisable in women who should not get pregnant for medical reasons or who have irregular periods and cannot predict when they are regularly ovulating.

Oral Contraceptives
The short-term, hormonal birth control choices are daily oral contraceptive pills (combined estrogen + progestin or progestin only pills), once a week contraceptive patches, once a month vaginal rings, or once every 3 months Depo-Provera injections. These methods are much more effective at preventing pregnancy if used properly than the non-hormonal birth control methods listed above. In addition, they usually regulate a patient’s menstrual period, decrease cramping, decrease the risk of ovarian cysts and protect against uterine and ovarian cancer. The risks depend on the method chosen. The combined estrogen and progestin methods may cause nausea, bloating, breast tenderness, breast changes, mood changes, headaches, changes in vaginal discharge, bleeding in between periods, decreased sex drive, hair/skin changes, appetite/weight changes, and elevated blood pressure. Rarely they can cause venous blood clots, stroke and heart-attack. This risk increases in smokers older than 35 years old. Therefore, tell your doctor if you smoke. The progestin-only methods do not have the risk of blood clots, stoke, heart attack or elevated blood pressure and are usually able to be prescribed in patients that are not able to take estrogen therapy.

Long Term Birth Control Methods

Non-Hormonal
The only long-term, non-hormonal, birth control choice is the Paraguard/Copper IUD (intrauterine device). It is the most convenient non-permanent form of birth control since is lasts for up to 10 years. It is highly effective at protecting against pregnancy, about 99%, an advantage over the short-term methods. It doesn’t have the benefits or the risks of hormonal therapy. The most common side effects are breakthrough bleeding and pelvic cramping. The paraguard IUD can be placed during a doctor’s office visit after an initial history and pelvic exam.

Hormonal
There are two long-term, hormonal, birth control choices: the Mirena IUD (intrauterine device) and the Implanon subdermal (under the skin) implant. The Mirena IUD is a levonorgestrel-releasing (progestin only) intrauterine system placed in the uterus to prevent pregnancy for as long as desired for up to 5 years. Mirena also treats heavy and prolonged periods and cramping. The Implanon device is a etonogestrel-releasing (progestin only) subdermal implant that is placed under the skin of the upper, inner arm to prevent pregnancy for as long as desired up to 3 years. Both methods are highly effective at protecting against pregnancy, about 99%, an advantage over the short-term methods. Both methods usually lighten periods and sometimes take them away altogether which is not harmful as long as you stay on a hormonal method prescribed by your doctor. Since both methods are progestin only methods and do not contain estrogen, the possible side effects may include nausea, bloating, breast tenderness, breast changes, mood changes, headaches, changes in vaginal discharge, bleeding in between periods, ovarian cysts, pelvic cramping, decreased sex drive, hair/skin changes, and appetite/weight changes. If pregnancy does occur, there is a higher risk of ectopic (tubal) pregnancy. The Mirena IUD and the Implanon subdermal device can be placed during a doctor’s office visit after an initial history and pelvic exam.

Tubal Ligation
Permanent tubal sterilization is an alternative option for women who have completed their childbearing or who do not wish to have children. It accounts for about 28% of contraceptive method use by U.S. women aged 15–44 years. It is greater than 99% effective, which is more effective than short-term, user-dependent reversible methods. Permanent tubal sterilization is NOT reversible as the name implies. In addition, this procedure does not protect against sexually transmitted diseases, including HIV infection. Thus condom use is still advised for protection against STDs. Complications are rare, but the most common issue is REGRET in the future. Therefore, this method is not advised for young women. Recovery is varied, depending on the approach utilized. The most common approaches are via mini-laparotomy immediately post-partum, laparoscopically and transcervically. The latter two approaches are described below.

In-office Permanent Tubal Sterilization
Essure Permanent Birth Control is a procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor’s office and is covered by most insurance providers. Depending on your specific insurance plan, payment may be as low as a simple co-pay.

The Essure procedure requires no cutting, general anesthesia, hormones or recovery time. It only requires mildly sedating intramuscular and oral pain relief and relaxation medications. Sometimes local anesthesia is also administered to the cervix if needed. The procedure itself takes no longer than ten to fifteen minutes. A soft, flexible micro-insert is delivered through the vagina and uterus and placed into each fallopian tube. Tissue grows into the micro-insert usually over 3 months and forms a natural barrier so the sperm cannot reach the egg. Most women resume their normal activities within one day. Essure Permanent Birth Control has been FDA approved since 2002. Patients will need a reliable back-up birth control method for 3 months following the procedure and a post-procedure test is recommended to ensure that the procedure has been successful.

Learn more about this procedure by calling AMIGS at (404) 355-4885, visiting the website www.essure.com or by calling the Essure information line at 1 (877) ESSURE1.

Laparoscopic Tubal Ligation
For patients who desire permanent sterilization and cannot or do not wish to have the Essure procedure, we offer Laparoscopic Bilateral Tubal Ligation in the outpatient surgery center. This procedure is minimally invasive, but requires general anesthesia. Usually only one 10mm incision is made in the umbilicus and the fallopian tubes are either ligated using bipolar cautery or application of permanent clips. Post-operative pain is usually mild. Most women resume their normal activities within two-three days and recovery is mainly due to recovery from anesthesia effects and returning to normal bowel movements. The effect is immediate and patients do not need a back-up method of birth control.

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