The Family Groove | Control Issues | Pills, IUDs, Rings, Oh My! So Just What are you using these days?

CONTROL ISSUES
PILLS, IUDS, RINGS, OH MY!
SO JUST WHAT ARE YOU USING THESE DAYS?

Birth control today ain’t what your mama used.
Heck, it’s even changed since you were in college.
There are pills on the market that can shorten your
period to four days (or get rid of it completely),
set-and-forget rings, and a variety of longer-term
options that didn’t exist only a few years ago.
So what’s best for you? It really depends on a variety
of factors, like whether you’ve already had children, how long you are looking to use birth control and, of course, what makes you comfortable both mentally and physically. Here, we give you the must-know scoop on the latest options with the help of Dr. Randy Fink, a well-respected gynecologist/obstetrician based in Miami.

Long-Term
If you’re looking to not get pregnant for more than a year and a half, there are basically three options that are ideal: Mirena, ParaGard and Implanon. The first two are an intrauterine device, commonly referred to as an IUD (a small, flexible plastic device that’s inserted into your uterus by a doctor, until it is removed by a doctor—no operation is required), and the third is a small, matchstick-like device that’s inserted under the skin of your arm. “While we’ve made great advances in hormonal birth control, you still have to pay for it every month, go to the pharmacy and pick it up, and you still have to do something on a day-to-day basis [if you’re using the pill],” says Dr. Fink. These options provide peace of mind without invading your daily routine. In addition, long-term solutions like these are great for women who are done with childbearing but don’t want surgery. They’re just as effective as getting your tubes tied (each has less than a 1 percent chance of failure).

Mirena is an IUD that can stay in place for up to five years, but it can be removed earlier if you decide to try to get pregnant. Once removed, you can get pregnant immediately. The T-shaped IUD delivers a small amount of the hormone levonorgestrel directly to your uterus, essentially thinning out its lining to prevent sperm from moving around and finding the egg. As Dr. Fink puts it, “If you take water out of the pool, you can’t swim.” This can also result in a lighter period—women on Mirena have seen up to a 90 percent reduction in flow—so it’s also used to treat women who suffer from heavy menstrual cycles. However, it’s also not unusual to have irregular periods for the first few months. Mirena is FDA-approved for women who’ve had at least one child and are looking for a more long-term solution.

If you haven’t yet had a child but are looking for a long-term option, ParaGard might fit the bill. ParaGard is a non-hormone IUD. Like Mirena, it’s made of flexible plastic that you won’t feel inside you, but unlike Mirena, ParaGard is wrapped in copper, which is a natural spermicide. This means you won’t feel the side effects that are sometimes associated with the hormones in other options, like weight gain or moodiness, but it also means you won’t get the benefit of lighter periods. The device can stay in for up to 10 years, but can be removed earlier, too.

With both IUD options, it’s totally safe and commonplace to replace an expiring IUD with a fresh one if you want to continue using birth control. And once you stop using the device, your chances of conceiving start immediately. In fact, that’s true with all birth control, regardless of form. (Side note: Dr. Fink hypothesizes that the “you have to wait three months after stopping birth control before you can get pregnant” myth might stem from the recommendation that women take a vitamin containing folic acid for a few months prior to conception because it decreases the risk for certain kinds of birth defects.)

There’s a third option for those who are looking for long-term birth control: Implanon. Implanon is a hormonal birth control in the form of a small, slender rod that is inserted under the skin of your arm about 6 centimeters above your elbow. The rod is 40mm long, 2mm wide, and looks similar to a matchstick. While you can’t see the device, you can feel it if you touch the area. “It’s a great, long-term and highly effective birth control that’s great if you don’t want something inside the uterus,” says Dr. Fink. Implanon is FDA-approved for women who haven’t had children, as well as those who have. It takes only about 15 seconds to place it (though removal takes a few minutes) and, like the IUDs, can be done in a doctor’s office. Implanon is effective for up to three years, after which time it can be replaced with a new one (and like an IUD, your ability to conceive returns to its natural state once it’s removed). It is the most effective birth control available; no one has ever gotten pregnant while using Implanon (it’s been on the market since 2006).
Pills

Short-Term
So what are your options if you’re looking for a short-term birth control solution? Dr. Randy’s first suggestion is the NuvaRing, a small, flexible plastic ring that you insert into your vagina and leave in for three weeks at a time. “It’s the bomb!” says Dr. Fink. “The pill is sort of like a ball and chain, and after women try the NuvaRing, it’s like ‘Wow! I didn’t know there’s so much freedom!’” Through the bloodstream, your body absorbs a combination of estrogen and progesterone from the ring. It’s designed to mimic the three-weeks-on, one-week-off cycle of the pill—after you remove the ring at the end of the third week, you menstruate, and then you insert a new one a week later. You can’t ever feel the ring (though your partner might be able to during sex, if only slightly), and it rarely falls out. One of the biggest pluses is that is has one of the lowest doses of hormone available in terms of any birth control, so the side effects are minimal. “It’s the greatest thing since sliced bread in terms of contraceptives,” says Dr. Fink.

Another option is one of the new extended-cycle contraceptives now available. These are daily hormone pills that are designed to either shorten your period’s length and frequency or even eliminate it all together. And while some women may think this odd or unnatural, it’s totally safe and healthy. “Some women want to have that monthly bleeding,” says Dr. Fink. “But there’s absolutely nothing unhealthy about suppressing the menstrual cycle with birth control.” The only reason you have your period when you’re on the pill is because when you stop taking the hormone pill and switch to the placebos, your body flushes that uterine lining. But as you probably know, you can skip your period by skipping the placebos and starting a new pack of pills right away (in that sense, essentially any pill can become an extended-cycle pill). “When you’re on birth control, the only reason you have a period is marketing. Traditional pills are designed to mimic the natural cycle, which says that you bleed every month,” explains Dr. Fink. “But the only thing the bleed tells you is that you failed every month to get pregnant.” And while that’s a good failure in this case, it’s an unnecessary reminder.

Of these new extended-cycle options, Lybrel is the first and only FDA-approved pill that is meant to be taken 365 days a year. It releases a low dose of estrogen/progesterone into the body daily, without a break. You still have to take it at the same time every day, like a regular pill, and at the beginning, you might see some spotting.

If you feel more comfortable having your period a few times per year but not monthly, Seasonale and Seasonique are options that reduce your menstruation to four times a year. You take the pills in a three-month cycle—84 days on, then seven days off, which is when you get your period (though unscheduled bleeding is more likely on these pills than with traditional ones). The only difference between the two is that while Seasonale’s off-day pills are pure placebos, Seasonique’s fuel your body with a very low dose of estrogen during your period, which they say helps ease breakthrough bleeding.

The other options in the extended-cycle category are pills that shorten your period but maintain the once-a-month frequency. Loestrin 24 and Yaz both fall into this category, with 24 days of an active pill, then four days of a placebo, during which you get your period. Both pills have their individual strengths: Loestrin 24 very reliably shortens and lightens your period, according to Dr. Fink, while Yaz is FDA-approved to treat the very severe form of PMS known as PMDD (premenstrual dysphoric disorder).

Whatever form of contraceptive you decide to use, make sure to talk it over with your doctor first. And if the first one you try isn’t right for you, don’t give up. “There is a birth control option for almost any person,” says Dr. Fink. “A lot of people might have had a bad experience maybe 10 years ago, but nowadays, there are so many options, and side effects have become more favorable. There’s something out there for everyone, if you keep an open mind.”

—Erin Scottberg

Erin Scottberg is a writer, photographer and graphic designer based in Brooklyn. She’s currently the research editor at Popular Mechanics magazine and also writes for Lemondrop.com. Visit www.erinscottberg.com to learn more.

For more information about Randy A. Fink, MD, please go to www.drrandyfink.yourmd.com.

Check back next month to see what Dr. Fink has to say about permanent sterilization options.