With so many birth control methods available today, many women find it overwhelming to select the “right” birth control for themselves. It’s okay that you may not like the birth control method your friend suggests is “perfect.” Your decision about what’s “right” for you will be influenced by various factors, including the birth control method’s effectiveness, cost, invasiveness, and your personal religious or philosophical beliefs.
In an effort to help our patients navigate among the many birth control methods today, we are creating a three-part series on birth control methods. This is the second article in the series. The first article is Birth Control with Tubal Ligation.
This article addresses three types of commonly used birth control methods – the pill, the patch, and the vaginal ring. All of which fall under the category of “Short-Acting Hormonal Methods.”
What are Short-Acting Hormonal Methods?
Short-acting hormonal methods are hormonal contraceptives that a healthcare provider prescribes to prevent pregnancy by interfering with ovulation and the fertilization of a woman’s egg. The three most common short-acting hormonal methods are the pill, the patch, and the ring, all of which we will discuss below.
Short-acting hormonal methods can be as effective as long-acting reversible contraceptives (LARCs) in “perfect use” situations, where the woman remembers to take the pill as prescribed or replace the patch during the correct week. However, with “typical use,” the CDC reports that 9 in 100 women become pregnant during the first year of using these methods. They are considered a very effective form of birth control but are not nearly as effective as long-acting reversible contraceptives (LARCs) or sterilization methods due to human error. They require a woman to remember to follow the dosing every day or month, depending on the type of birth control, to achieve the 99% effectiveness of LARCs.
The birth control pill is a type of oral contraception that falls in this class of short-acting hormonal methods. It was approved by the FDA on June 23, 1960 and has become commonly known as “the pill” because it comes in pill form. Since its inception, the pill has revolutionized women’s health over the last five decades.
How does the pill work?
The pill works by suppressing ovulation so that no egg is released by the ovaries for fertilization by sperm. It suppresses ovulation by introducing hormones into the women’s body – estrogen alone or a combination of estrogen and progestin. Doctors prescribe that women take the pill orally once a day, and it is most effective when taken consistently at the same time each day.
The benefits of taking the pill
Beyond its abilities as an oral contraception, women have used the pill over the years to ease other health issues. The pill can:
- Regulate or lighten menstruation
- Prevent anemia by making periods lighter or shorter
- Lessen menstrual cramps (dysmenorrhea)
- Manage premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)
- Treat polycystic ovary syndrome (PCOS)
- Treat endometriosis or uterine fibroids
- Lower the risk of ovarian cancer, uterine cancer, and colon cancer
- Improve acne
- Stop unwanted hair growth
- Reduce migraines
- Control hot flashes during the transition into menopause.
Side effects of taking the pill
Some women experience side effects when starting the pill. These side effects often improve after a couple of months. Tell your healthcare provider if you experience any side effects. He may suggest changing your prescription to another brand that your body responds to without the side effects.
However, simply waiting out the symptoms for a few cycles often helps resolve many of the symptoms, especially when first starting a new pill regimen. Potential side effects include:
- Breast tenderness or swelling
- Irritability or moodiness
- Spotting between periods (abnormal menstruation).
The birth control patch is another type of contraception that is considered one of the short-acting hormonal birth control methods. The patch is like a small bandage that you stick on your skin. Once attached, it releases the hormones estrogen and progestin into your system.
“These are the same two hormones found in most birth control pills,” says Dr.Fliedner. “For women who don’t want to be concerned with remembering to take the pill daily, the patch delivers the hormones in a more manageable form.”
Two different brands of the patch are available in the U.S. with a doctor’s prescription. Simply stick the patch onto your lower back, arm or abdomen, and it releases a steady dose of the hormones.
Like the pill, the patch prevents your ovaries from releasing any eggs. The patch also thickens cervical mucus so that if an egg does manage to slip through (unlikely), sperm would have trouble reaching it.
Side effects of the patch
Much like the pill, the patch can cause similar side effects, including:
- Breast tenderness
- Irregular bleeding or spotting
- Increased risk of blood clotting problems.
“Side effects like sore breasts and spotting are most common during the first few weeks or months that you use the patch,” says Dr. Fliedner. “After that, they typically fade away as your body gets used to the hormones.”
Who is at risk of blood clots?
The risk of blood clotting is a bigger concern for some women. “Overall, the risk is relatively low in women using the patch,” Dr. Fliedner says. The risk of blood clots is much greater in pregnant women than it is in women using the patch to prevent pregnancy.
However, the patch does have a slightly higher risk of clots compared to the pill. For that reason, avoid it if you:
- Have diabetes
- Have a history of blood clots
- Had a heart attack or stroke
- Have a body mass index (BMI) over 30.
“For women with a higher risk of blood clotting diseases, there are safer alternatives, like low-dose birth control pills,” Dr. Fliedner says.
Benefits of the patch
Not all side effects of the birth control patch are adverse. In fact, some women use the patch mainly for the other benefits that go along with it, like:
- Less acne
- Milder cramps
- More stable moods
- Shorter, lighter periods
- Treatment for iron-deficiency anemia.
“Any woman looking for an effective contraceptive should consider the patch,” says Dr. Fliedner.
Vaginal Contraceptive Ring
The vaginal ring, too, is one of the short-acting hormonal birth control methods that a physician must prescribe. It’s a small, flexible, plastic ring, about two inches in diameter, that you insert into your vagina to prevent pregnancy.
This method of birth control is also known by the two leading brand names:
- NuvaRing. NuvaRing is a vaginal ring that has to be changed out for a new ring monthly.
- Annovera. Annovera can be rinsed and reinserted monthly. One ring should last you a full year.
How the ring works
The vaginal ring prevents pregnancy by steadily releasing estrogen and progestin into your vagina that prevents the release of an egg each month. It also thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so a fertilized egg is less likely to implant itself.
Who can use the vaginal ring?
Some women can’t use the vaginal ring.
It may not be suitable if you:
- Have had a blood clot in a vein or artery
- Have had heart or circulatory problems, including high blood pressure
- Are 35 or older and smoke or stopped smoking in the past year
- Have migraines with aura (warning symptoms)
- Have had breast cancer in the past five years
- Have diabetes with complications
- Are overweight
- Take medicines that may interact with the ring
- Can’t hold the ring in your vagina.
If you don’t smoke and there are no medical reasons why you can’t use the ring, you can use it until you’re 50 years old.
Advantages of the vaginal ring
- It doesn’t interrupt sex.
- It’s easy to put in and take out.
- You don’t have to think about it every day or each time you have sex.
- The effectiveness of the ring isn’t affected if you’re sick (vomit) or have diarrhea.
- It may help with premenstrual symptoms.
- Period-type bleeding usually becomes lighter, more regular, and less painful.
Disadvantages of the vaginal ring
- You may not feel comfortable inserting or removing it from your vagina.
- You can have spotting and bleeding in the first few months.
- It may cause temporary side effects, such as increased vaginal discharge, headaches, nausea, breast tenderness, and mood changes.
- You need to remember to change it and put in a new one. If remembering to do this is difficult, a longer-acting method such as the contraceptive implant or intrauterine device (IUD) may be more suitable
- Some medicines can make the ring less effective. Discuss all medications you are taking with your doctor before he prescribes the vaginal ring.
- It may take a while for you to return to normal fertility. Some women take a few months to get pregnant after they stop using the vaginal ring.
Which Birth Control Method Is Best?
There is no “best” method of birth control. The birth control method that is right for you and your partner depends on many things and may change over time.
Before choosing a birth control method, talk to your doctor or nurse about your questions. We list some great topics to consider below.
- Consider your plans to get pregnant in the future – soon, in a few years, or never.
- Discuss with your doctor the effectiveness of the contraception you are considering.
- Discuss any possible side effects with your health history.
- Consider your frequency of having sex.
- Review your overall health and any limitations you may have with a birth control method.
- Really think about how a birth control method fits in with your personality and lifestyle (For example, can you remember to take a pill every day? Will you have to ask your partner to put on a condom each time?).
Lastly, we need to inform you that none of these birth control methods protect you from sexually transmitted infections (STIs).
Trust Dr. Fliedner With Your Reproductive Health
With over 30 years of experience counseling women about their reproductive health, Dr. Fliedner is the perfect one to help you navigate the myriad options of birth control methods.
We look forward to seeing you!