Weighing contraception choices
In my last column, I reviewed some of the contraception options. Now I will discuss hormonal contraception and IUDs.
Many hormonal contraceptives exist for women. Skin patches, vaginal rings and some pills contain two types of hormones, an estrogen and a progestin. Other types of pills, injections and implants contain one hormone, a progestin. Methods that do not require frequent action on your part (such as shots or implants) are more effective than those that must be taken daily, weekly or monthly. Pills work best when taken daily at the same time.
There are many different formulations of contraceptive pills. Some hormonal contraceptives have desirable side effects, including reduced acne, fewer premenstrual symptoms, lighter periods, less severe migraines and fewer periods. Some hormonal methods may also reduce your risk of ovarian and uterine cancer by inhibiting ovulation (the release of an egg) and/or reducing the thickness of the lining of the uterus.
Common unwanted side effects from hormonal contraception include nausea, breast discomfort, headache, weight changes, spotting between periods and mood changes. If you experience side effects that bother you, do not stop using the contraception until you have another method in place. Contact your healthcare provider to discuss using a different formulation, dosage or method.
Less common, but more serious symptoms that may signal a complication (such as blood clots) include trouble breathing, chest pain, severe headaches, blurred vision and/or aching in the legs. If you have any of these symptoms, contact medical help immediately. Smokers, women who are very overweight or those with family or personal history of blood clots have a higher risk of developing blood clots while on birth control containing estrogen. There is also a higher risk of pregnancy complications for these women and I recommend seeking medical advice prior to planning a pregnancy.
Intrauterine devices (IUDs) are one of the most dependable types of birth control outside of sterilization. There are two types: one with progesterone hormone effective for five years and one with copper that is good for 10 years. IUDs are put in place during a short office procedure. If you decide you want a pregnancy, another in-office procedure is necessary to remove the IUD.
The progestin-only IUD can cause lighter or absent periods until removal; however it can occasionally have unwanted side effects similar to other progestin-only contraception. The copper IUD can cause longer and heavier periods, but has no hormonal-type side effects. Other infrequent side effects of both types of IUDs are backaches and headaches.
It is recommended that women who choose an IUD are in a monogamous relationship because STIs like gonorrhea or chlamydia could cause a more severe pelvic infection if you have an IUD. If you have multiple partners, using a condom can protect you from this risk.
A very rare complication occurs when the IUD penetrates the uterus or ends up outside the uterus in the pelvis. Discuss the risks and benefits with your health care provider.
If you have intercourse without any form of contraception, you can prevent pregnancy by getting a higher dose hormonal contraceptive pill called Plan B or have an IUD inserted within 72 hours of intercourse. Any later and these methods are not effective. Plan B is not meant to terminate an existing pregnancy and is intended to be emergency contraception rather than something that is used regularly.
An online resource ( http://www.arhp.org/ methodmatch/) at the Association of Reproductive Health Professionals can help you review options based on your unique birth control needs. Your contraception choice should be both dependable and easy for you to use. Your healthcare provider can help you decide.
Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.