Empower your sexuality with knowledge
Are you ready for diaper changes, midnight feedings, and a lifetime commitment to raising a child? If the answer is no, then it is time to educate yourself on birth control options.
Contraception access has improved
In 2008 the Affordable Care Act requiring no-copay contraception coverage became the law. Access to birth control improved. Unintended pregnancy, teen pregnancy, and abortion rates did not just decrease; they plummetted. Regardless of our political views, I hope we agree that we want to empower women to be pregnant when they want to be.
45% of US pregnancies are unintended
Despite the last decade’s improvement in access to affordable contraception, almost half of the pregnancies in the United States are unintended. Unintended does not indicate unwanted, but an Obgyn’s job is to help women be pregnant on their terms when they want to be.
This statistic haunts me
A haunting statistic for an Obgyn is that half of the unintended pregnancies occurred in women who were using birth control at the time of conception (Guttmacher). One way to decrease the risk of an unplanned pregnancy is to choose an effective form of birth control that puts you in control. The most effective forms of non-permanent birth control are called LARCs — Long-Acting Reversible Contraception
What is a LARC?
Long-acting reversible contraception includes birth control methods that work for an extended period of time. Examples of LARCs are IUDs (Intrauterine Device) and subdermal implants (Nexplanon). An IUD is a small device inserted into the cavity of the uterus. There are currently five IUDs available in the US — Kyleena, Skyla, Mirena, Paragard, and Liletta. There is only one subdermal implant available.
After a one time insertion, a patient can then leave with the confidence of years of protection. The return to fertility is almost immediate, with pregnancies seen as early as seven days after removal. LARCS have the lowest failure rates, highest continuation rates, excellent safety profiles, minimal side effects, and few medical contraindications.
What is Nexplanon?
Nexplanon the most effective reversible birth control option on the market. It is a single 4cm rod implant inserted just under the skin of the inner arm. It is small, thin and about the size of a toothpick. The location on the arm makes it discreet and unnoticeable. It contains progesterone that is slowly released to stop the ovary from releasing an egg.
The insertion process is quite easy. We mark the area of the arm for insertion and inject a local anesthetic to numb a small area on the inside of your upper arm. Then, the Nexplanon device is gently inserted just below the skin. The device is FDA approved to stay up to three years. The Nexplanon does not protect from any sexually transmitted infections. There are no long term side effects of using the Nexplanon.
The most common side effect of Nexplanon is the alternation of the menstrual cycle. Some have no periods, while others may have irregular spotting. Unscheduled bleeding is common with progesterone-only forms of birth control. It is annoying but not harmful.
The type of progesterone in Nexplanon is called etonogestrel. It is not an appetite stimulant like other forms of progesterone. Nexplanon is not directly linked to weight gain.
Who can not use Nexplanon
Contraindications to Nexplanon include pregnancy, certain clotting disorders, undiagnosed uterine bleeding, active liver disease, breast cancer, other progesterone sensitive cancers, or those with an allergic reaction to Nexplanon. Nexplanon may interact with certain medications metabolized by the liver.
What is an Intrauterine device (IUD)?
An IUD is a small T-shaped device inserted into the cavity of the uterus. In the US, there is one hormone-free IUD and four progesterone IUDs. An experienced Obgyn can place the IUD with very limited discomfort. The IUD offers hassle-free contraception for years. IUDs are FDA approved for all women regardless of pregnancy history. It is a myth that you have to have had a baby to qualify.
How long can you use an IUD
How is it inserted?
A device called a speculum is gently inserted into the vagina to open up the walls allowing visualization of the cervix. The cervix is the opening of the uterus at the back of the vagina. The IUD is then gently guided into the cavity. There are a variety of techniques that a health care professional can employ to ease the discomfort of an IUD insertion.
Progesterone IUDs include Mirena, Kyleena, Skyla, and Liletta. The small, plastic, T-shaped device contains a type of progesterone called levonorgestrel that is released into the cavity of the uterus. The progesterone thickens the cervical mucus, killing sperm deposited in the vagina. It does not work by causing abortion. Progesterone also thins the lining of the uterus. A thin lining may improve or even eliminate menstrual bleeding. Only tiny amounts of progesterone are absorbed throughout the body (less than what is produced by the ovary naturally).
Paragard is the only available hormone-free IUD. The T-shaped device is wrapped in a small amount of copper. The copper creates an inflammatory response in the lining of the uterus and the cervix which . kills sperm on contact. Paragard does not work by causing abortion. Some patients may experience worsening of their periods with a copper IUD. Most do not. Paragard is FDA approved for emergency contraception if placed within five days of unprotected intercourse.
IUD side effects
Side effects include altered bleeding patterns, cramping with insertion, IUD expulsion, and a small risk of uterine perforation during insertion. Removing the device is simple as long as the string is visible. Removal requiring surgery is rare.
Who can not use an IUD?
You can not get an IUD if you have an active infection, undiagnosed bleeding disorders, cervical or uterine cancer, or a distorted uterine cavity. Those with breast cancer or other hormone-sensitive cancers should avoid a Progesterone IUD. Those with a copper allergy or Wilson’s disease do not qualify for Paragard.
Knowledge is power
The best birth control is the one that you will use. There is no perfect option for everyone. If you have sex and do not want to be pregnant, then choosing a method empowers you to be in control of your body. Birth control gives you freedom.
By: Dr. Jeff Livingston