The Contraception Conundrum: Finding A Method That's Effective And Safe
By Catherine Monahan
If you are the kind of woman who eats organic produce, uses chemical-free body care products and keeps current on what supplements you need, it is likely that you are frustrated by the lack of natural birth-control options. Of course those options do exist; they just require considerable effort, dedication and sometimes abstinence, three compromises that many women are not always willing to make. If you fall into this category, your best bet is to find a safe conventional method that you feel comfortable using. While the choices have certainly improved a great deal over the years, they still carry with them a few risk factors. The following guide will help you navigate the array of contraceptive choices currently available, tell you how they work, and outline their advantages and drawbacks so you can choose one that best fits your healthy lifestyle.
If you are looking for a natural contraceptive method that goes beyond withdrawal or total abstinence, natural family planning may be the down-to-earth birth option for you. Natural family planning doesn't require office visits or stubborn rubber inserts—just a special thermometer, a few charts and a serious commitment from both partners.
If you decide on natural family planning, you'll track and chart your body temperature, vaginal mucus and the number of days in your menstrual cycle. After three months, you should be able to accurately predict fertile days and either abstain from sex on those days or use an alternative form of birth control.
Natural family planning can be quite reliable, but it takes some work. "If people want to be absolutely safe, I recommend they use barrier methods, so they're not missing sex 14 days of the month," says Kayla Moonwatcher, ND, who teaches natural family planning in Boulder, Colo. "Not everyone is willing to abstain."
Natural family planning classes are typically offered through health clinics or church organizations.
Improved Hormone Methods
For couples who are not inclined to abstain from sex during risky days, hormone-based methods are a reliable option. The latest hormonal contraceptives still contain an assortment of estrogens and progestins in a variety of dosages and combinations. Like the original birth-control pill, they work by preventing the ovaries from releasing eggs (ovulation) and by keeping the cervical mucus so thick sperm can't easily pass through it.
The big difference between today's hormone methods and their pill predecessor is convenience. New delivery techniques such as implants, injections and modern IUDs are sidestepping the occasional memory lapse associated with taking 28 tiny pills, one each day of the month.
Women forget to take the pill simply because it's hard to remember, says Anita Nelson, MD, professor of Obstetrics and Gynecology at UCLA School of Medicine. "The pill should have less than 1 percent of women getting pregnant, but 5 percent do," she says.
New methods also deliver lower hormone doses at more constant rates than oral contraceptives. That means your chances of experiencing some of the side effects typically associated with the pill, such as weight gain, depression, nausea and breast tenderness, are much lower. The risk of more serious health problems, including blood clots and stroke, is also decreased, yet such complications are largely dependent on your medical history.
Implants: Norplant implants, available since 1990, are six rod-shaped capsules inserted just under the skin of the upper arm. The implants slowly release progestin levonorgestrel into the bloodstream and are effective for five years. A new two-rod system, sold under the name Jadelle, works for up to three years and is easier to insert and remove than Norplant. Some side effects and health risks of implants may include irregular bleeding, headaches, depression and weight gain. Pregnancies, if they occur, are more likely to develop in the fallopian tubes (ectopic). In addition, implants are sometimes visible beneath the skin and can leave a scar or skin discoloration after being removed.
Injections: Lunelle, a monthly injectable contraceptive, contains both estrogen and progestin, and if you use it, you'll have predictable monthly bleeding. The only other injectable birth control now available, Depo Provera—injected every three months—contains progestin and generally disrupts the menstrual cycle or eliminates it entirely. Side effects and health risks of Lunelle may include blood clots, heart attack and stroke, especially in women over 35 who smoke. Temporary irregular bleeding, loss of monthly period, weight gain, depression, nausea and breast tenderness have also been associated with this method.
IUDs: Traditional intrauterine devices (IUDs), T-shaped inserts made of molded plastic and wrapped with copper wire, fit inside the uterus and induce a mild inflammatory reaction that prevents sperm from fertilizing an egg. The more advanced Mirena IUD contains no copper but works instead by delivering levonorgestrel directly to the uterine wall. Unlike traditional IUDs, the Mirena generally reduces menstrual cramps and bleeding. It is effective for five years. Some side effects and health risks of IUDs may include an increase in cramps, spotting between periods, heavier and longer periods, an increased chance of tubal infection if you contract a sexually transmitted disease, and any pregnancies are more likely to occur in the fallopian tubes. On rare occasions the uterine wall has been punctured during IUD insertion or an infection has developed.
Patch: Estrogen and progestin combinations, much like those contained in birth control pills, can also be delivered through the skin by small patches worn on the back, tummy or buttocks. The weekly patches should be available within a year. The side effects and health risks of patches are similar to those of oral contraceptives.
Pills: Three new birth control pills are also due out soon. Two are said to deliver lower hormone doses, while the third, sold as Yasmin, contains a form of spironolactone, a diuretic commonly prescribed for high blood pressure. Also used to treat acne, spironolactone blocks testosterone production and helps control ovulation. Some side effects and health risks of traditional birth control pills may include blood clots, temporary irregular bleeding, loss of monthly period, weight gain, depression, nausea, breast tenderness, heart attack and stroke, especially in women over 35 who smoke.
Vaginal ring: About the thickness of a piece of spaghetti, the vaginal ring fits high inside the vagina and releases estrogen or an estrogen-progestin combination. The ring is removed one week out of four to allow for a period and must be replaced each month. It's easy to insert and remove by yourself and should be available within the year. The side effects and health risks of the vaginal ring are similar to those of oral contraceptives.
Emergency contraception: Often called morning-after pills, emergency contraceptives contain the same ingredients as birth control pills, but in higher doses. When used within 72 hours after a condom break or other birth-control mishap, it is not abortive; rather it prevents pregnancy by suppressing ovulation. Emergency contraception will soon be available without a prescription. Some side effects of emergency contraception may include nausea, vomiting and cramping.
Unlike emergency contraceptives, drugs such as mifepristone (RU 486) and prostaglandins stop pregnancy once you realize you've missed a period. Used in combination, they stimulate uterine contractions and are especially effective up to seven weeks after conception.
Condoms: If you've written off condoms as moisture-sucking mood slayers, think again. Male condoms are now available in more comfortable materials, sizes and shapes. Instead of the traditional, and sometimes allergy-provoking, latex rubber condoms, you might opt for a thinner, more sensitive polyurethane version. Natural, or lambskin, condoms are also considered more comfortable than latex, but they are slightly less reliable and do not prevent STDs.
The latest wave of condoms also fit more men. A new extra-large design is intended for the 6 percent of men who can't fit in a normal condom, while baggy, flared and contoured condoms offer alternative fits.
Other barrier contraceptives such as the diaphragm, cervical cap and female condoms haven't undergone any makeovers, but when used properly with spermicidal gel or foam, each remains an effective contraceptive.
As with any type of birth control, using it correctly is what matters. And finding a method that you feel comfortable with is the key to proper use. If a natural method is your preference, dedicate yourself to faithfully practicing natural family planning. If you need a more convenient method, then work with your health care provider to find one that will best suit your body.
Catherine Monahan is a health and science writer and a frequent contributor to Delicious Living.