The Truth about Birth Control and How to Choose the Right Kind

OK ladies, today I am going to tell you the truth about birth control and how to choose the right kind. Ultimately, YOU are in control of your body, and you have a choice of how you want to approach your pregnancy journey. There is absolutely no shame in wanting to go on birth control or maybe wanting to avoid birth control all together. 

However, it is important that you are informed on your options so you and your practitioner can make the best choice for you for the right reasons. What is the best birth control? How can you choose the best type of birth control for you? 

What is birth control?

Birth control is any method used in an effort to prevent pregnancy. Seems logical right? There are a myriad of different birth control methods including the pill, intrauterine devices (better known as IUDs), the birth control implant, the vaginal ring (NuvaRing), condoms, fertility awareness methods, abstinence, and several more. 

Yes, sometimes birth control is used for other reasons like alleviating serious acne, lightening heavy periods, or improving PMS symptoms, but we will get to that a little more later. Birth control can be separated into a few different categories:

• Hormonal birth control
• Non-hormonal birth control
• Lifestyle 
• Surgical methods

So let’s dive a little deeper into each method of birth control, how they work to prevent pregnancy, and what effects they have on your body.

Hormonal Birth Control

Hormonal birth control is the most common method mainly due to its effectiveness, accessibility, and user friendliness. Hormonal birth control comes in one of two forms:

• Estrogen and Progestin
• Progestin only

So, how do these work? Well, these hormones work to prevent pregnancy in two ways:

1. The estrogen and/or progestin from birth control throws off the natural increase in estrogen during the follicular phase. Since there is no estrogen surge, there is no signal to the brain to increase LH or FSH to continue the menstrual cycle. 

Without an increase in these hormones, no follicle is stimulated to release an egg, meaning no ovulation. No ovulation means there is no egg pushed into the uterus awaiting fertilization. This means there is no way to get pregnant.

2. These hormones also thicken the cervical mucus which makes it much more difficult for sperm to enter the uterus in the first place. 

Hormonal birth control comes in several different forms and most common are:

• The pill
• IUD
• Implant
• Vaginal Ring

The Pill

Birth control pills come in many forms, but there are 3 standard “packets” that they come in.

• 21 day packet: 1 pill every day, skip for 7 days
• 28 day packet: 1 pill every day with 7 days of a placebo
• 91 day packet: 1 pill every day with the last 7 days as a placebo

All three of these can come with that combo of estrogen and progestin or only progestin. What is best for you depends on your lifestyle and risk factors. You want to avoid the birth controls with estrogen if you have a history of blood clots, a blood clot disorder, risk of estrogen related cancers, history or risk factors of heart attack/stroke, high blood pressure, diabetes, or liver disease. 

The pill is 91% effective, but common usage errors bumps that number down to about 88%. Yes, you have to take it properly for it to work properly. A daily alarm or usage of an app can help you stay on track. Many pills are covered by the majority of insurances which makes it a very popular birth control method. 

At this point, the pill has been used for over 50 years. It is very safe and effective for preventing pregnancy. There are too many brand names to count with different combinations of hormones, so it is important to work with your practitioner on the brand best for your health and your lifestyle. 

IUD

An Intrauterine Device or IUD is exactly what it sounds like: a device that hangs out in your uterus. This device sits there, preventing pregnancy for at least  3 and up to 12 years (depending on the type). 

The idea of how this device gets there can be a little scary, but the procedure is done by a medical professional and does not take very long. There is some cramping and pain that can occur, but here’s a little pro tip: Get the procedure done during your period. Your cervix is more relaxed making insertion easier and less painful. Taking some pain relievers like Ibuprofen or Naproxen before the procedure can also help with the pain. 

There are currently 5 IUDs approved in the US:

• Paragard- lasts up to 12 years and is the only non-hormonal IUD
• Mirena- lasts up to 7 years
• Kyleena- lasts up to 5 years
• Liletta- lasts up to 7 years
• Skyla- lasts up to 3 years

IUDs contain progestin which works the same way as they do in the pill to prevent pregnancy. The hormone dosage is less in the IUD as the hormones have much less distance to travel (duh, these are basically at the source). 

Let me address Paragard, the only non-hormonal copper IUD. This device is actually wrapped in copper to prevent pregnancy. Copper and sperm are not friends. Copper disrupts the motility of sperm preventing it from entering the uterus. No sperm means no pregnancy.

This IUD is just as effective as the others, but has different side effects. While you have the benefit of keeping your cycle on Paragard, heavier periods and worse PMS symptoms can occur. You should also avoid Paragard if you have a copper allergy or blood clotting disorder. 

What is nice about these devices is that you don’t have to worry about it, once it’s in. Once inserted, you don’t have to worry about any kind of maintenance. You get to carry on with life while your IUD rocks its job at 99% effectiveness. 

Birth Control Implant

The birth control implant (Nexplanon) is another “get it and forget it” tool to prevent pregnancy that lasts up to 3 years. Contrary to the IUD placement in the uterus, this matchstick sized device is placed under the skin of your upper arm. It releases progestin just like the IUDs to prevent pregnancy with 99% effectiveness. With a little numbing, the insertion is quick and only leaves some bruising and mild aching. 

The implant is a great alternative over an IUD if you have had recent pelvic infections or cervical/uterine cancers which would contraindicate IUD insertion.

Vaginal ring

The vaginal ring (NuvaRing) is a small flexible ring that is worn inside the vagina. This device contains estrogen and progesterone similar to the combination birth control pills. The ring has enough hormones for up to 5 weeks, but you can choose to replace it every 3, 4, or 5 weeks. 

You also have the choice of keeping a period by either leaving it out for 7 days before replacement, or always keeping one in (you’ve got the power on this one!). REMEMBER this period is still not a true ovulatory period because no ovulation is occurring.

Although pretty simple, this method can definitely fall with some user error. When used correctly it is 99% effective, but typical use puts it at about 91% effective. The same precautions regarding the estrogen in this method should be considered as mentioned above. 

Lifestyle Methods

Let’s now touch on some birth control options that don’t alter your hormones and that you can use on a day to day basis!

Condoms

Condom use for vaginal intercourse stops sperm from entering the vagina in order to prevent pregnancy. This is pretty common knowledge, but shouldn’t be forgotten as an effective birth control method. Condoms are 98% effective when used correctly. A female condom may be another option to look into, but they can be quite awkward to use. 

Remember this is the only method that also prevents sexually transmitted infections, so wrap it up ladies!

Fertility Awareness Methods

This method is your chance to really hone in on the power of your menstrual cycle. You start by tracking your cycle in order to pinpoint ovulation and the days you can actually get pregnant. This takes some work as you will need to pay attention to factors like:

• Total length of cycle
• Length of period
• Cervical mucus thickness
• Basal body temperature

There are many apps that can help keep your cycle tracking accurate, but this method has around 76-88% effectiveness depending on accuracy, so I recommend working with a practitioner in order to pin this one down!

Abstinence

Yes, not having sex is in fact a form of birth control. While it might be obvious, it is 100% effective and worth mentioning. Always remember you have the choice on what you do with your body! 

Surgical Methods

To wrap it up, I will touch briefly on the two available surgical birth control methods:

Sterilization

This is the female way to permanently ensure you will not get pregnant again, otherwise known as “getting your tubes tied”. In this procedure, the fallopian tubes are blocked so an egg can never reach the ovaries to get fertilized. You still may have a regular period, but you won’t be able to get pregnant. 

Vasectomy

This is the male way to permanently ensure he can’t get you pregnant again. This method only is effective for you if he is your only sexual partner. This surgical procedure involves blocking the tubes in the scrotum to prevent sperm from leaving the body. If there is no sperm, there is no pregnancy.

Big Picture for Your Reproductive Health

So now you know the most widely used methods to prevent pregnancy and understand the truth about birth control. You have the tools to decide which method is best for you when considering disease risk and issues with user error. I want to emphasize that going on a hormonal birth control IS NOT the solution to solving hormonal imbalances, bad acne, painful PMS, or long/heavy periods. 

Although hormonal birth control can alleviate these issues, it only covers up the root cause. Your period can be called your “fifth vital sign” and can create a beautiful insight into your health. If you are getting on birth control for reasons other than preventing pregnancy, you should work to solve those underlying issues instead of covering them up.