The main issues with old forms of contraception are increased appetite, resulting in weight gain, and other harmful side effects associated with birth control and contraception. Women no longer have to deal with annoying side effects of their regular birth control pills or worry about long lasting side effects. I introduce to you the two newest and safest long term contraception; Nexplanon and Mirena. Nexplanon is a three year contraception with very minimal side effects and Mirena is a longer term birth control with the added benefit of minimizing menstrual cramps.
Nexplanon is a subdermal progesterone only contraceptive implant that takes 10 seconds to place in the office. Side effects are minimal while the benefits are significant. Nexplanon offers reliable three years of birth control and less than one-pound weight gain associated with each year of use. It is particularly useful for teenagers, smokers, perimenopausal women and those with estrogen sensitive disorders such as menstrual migraines, a history of blood clots or rheumatologic disorders. Nexplanon can eliminate cyclical menses associated with pain and premenstrual syndrome. I have used it to eliminate migraines associated with menses for multiple patients. Nexplanon insertion requires special training from the manufacturer for insertion and removal.
Mirena is a progesterone containing intrauterine contraception, is another excellent reversible birth control method for the monogamous couple. Not only is it reliable, it provides five years of birth control and is exceptional for the treatment of menstrual cramps.
Of course we never forget condoms, whether you are dating and still looking for your life partner or divorced and looking for someone new. This is still the best protection for the prevention of sexually transmitted diseases.
Skyla is a new IUD from the manufacturers of Mirena. It is essentially the same as Mirena with a few changes. Skyla is ever so slightly smaller in size and has a lower dose of levonorgestrel , the active ingredient. Patients using Skyla will continue to have a period and have a lower risk of medication related side effect than the Mirena. The tube used to place Skyla is slightly narrower than with other IUDs, making it potentially more comfortable to place, especially for women who have never had a child. Skyla is an effective birth control option for women providing up to 3 years of protection.
Birth control pills have always helped with acne, excessive hair growth, premenstrual syndrome, menstrual cramps and heavy bleeding. I left the most common form of birth control for last because honestly there have been no major advances in Oral Contraceptive Pills in the twelve years that I have been practicing. Marketing of birth control pills comes and goes as the patent comes and goes. Every time a new one is introduced, it is proclaimed the next big thing but in reality, it is just the next most expensive thing.
What we do know is a shorter pill free (or sugar pill) interval does decrease breakthrough bleeding and may help with menstrual migraines. In addition, the lower the dose of estrogen, the lower the chance of blood clots, but the higher the chance of irregular bleeding. I should note that your chance of having a blood clot using pills is much smaller than the risk that results from getting pregnant making the benefits far out weigh the risks if unintended pregnancy occurs.
I still prescribe the same middle of the road, generic birth control as I did twelve years ago, that speaks volumes as to how few additional benefits there have been from the advertised pills. Like all treatments, each birth control choice is customized to the patient’s preferences and medical history.
Depo-Provera and Norplant are out, Nexplanon is in. Norplant was a disaster as an implantable contraception; doctors were not given training on proper insertion, making removal very difficult. For years, Depo-Provera was a mainstay of birth control as it only required an injection every 3 months and was a reliable contraception. the realization that after two years of use, osteoporosis (‘bone loss’) sets in, thus giving it a black box warning from the FDA.