Out with the old and in with the new
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 or long-lasting side effects of their regular birth control pills. The two newest and safest long-term contraception options are 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.
Oral Contraceptive Pills
Birth control pills are the most common form of birth control and have always helped with acne, excessive hair growth, premenstrual syndrome, menstrual cramps, and heavy bleeding. 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.
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. It should be noted 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 outweigh the risks if unintended pregnancy occurs.
Like all treatments, each birth control choice is customized to the patient’s preferences and medical history.
The Caya diaphragm is a new, safe contraceptive. It was developed together with users in an intensive research process in the USA. Caya is inserted into the vagina, directly in front of the cervix, to prevent sperm cells from entering.
How Caya works:
- is inserted into the vagina like a tampon
- it is placed between the posterior vaginal vault and the space before the pubic bone
- covers the cervix
- acts as a mechanical barrier that prevents sperm from entering the uterus
Caya must always be used in combination with a contraceptive gel. (e.g. Caya® Gel).
After use, the Caya diaphragm need only be cleaned with soap and water. Disinfectants do not need to be used and are not recommended. The Caya diaphragm can, in principle, be boiled. After a vaginal infection, the Caya diaphragm should be replaced with a new one.
For years, Depo-Provera was a mainstay of birth control as it only requires an injection every 3 months, is reliable contraception and inexpensive. The FDA has placed a black box warning on this medication as use beyond two years is associated with osteoporosis (bone loss). The main side effects of Depo-Provera are increased appetite with resultant weight gain and irregular bleeding. Depo-Provera can take up to a year to leave your system. Our practice does not recommend the use of Depo-Provera.
Mirena, a progesterone-containing intrauterine contraception, is another excellent reversible birth control method for the monogamous couple. Not only is it reliable, but it also 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 effects 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.
Nexplanon is a subdermal progesterone-only contraceptive implant unlike permanent contraception, 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. It has also been used to eliminate migraines associated with menses for multiple patients. Nexplanon insertion requires special training from the manufacturer for insertion and removal.
Birth Control Ring
A birth control ring (brand name NuvaRing®) contains 2 kinds of female hormones, estrogen and progestin, which work together to prevent pregnancy. They are the same kind of hormones found in the pill and they work the same way to prevent pregnancy even though they are administered differently with the ring. Once you place a birth control ring in your vagina, it releases a continuous low dose of hormones that helps prevent pregnancy. When used as directed, the ring has been shown to be 98% effective. You don’t have to think about taking it every day.
The birth control ring is used in a 4-week cycle. Keep the ring in your vagina for 3 weeks (21 days) and then remove it for a 1-week (7-day) break. Regularly check that the ring is in your vagina (for example, before and after intercourse) to ensure that you are protected from pregnancy. The ring should be inserted and removed on the same day of the week and at the same time. (For example, if you insert your the ring on a Monday at 8:00 AM, you should remove it on the Monday 3 weeks later at 8:00 AM.) You will usually get your period during the 1-week break that you remove the ring.Insert a new ring after the 1-week break. The new ring should be inserted on the same day of the week and at the same time that you inserted it the last month, even if your period has not stopped.
Important Safety Information
Do not use the ring if you smoke cigarettes and are over age 35. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives (CHCs) including heart attack, blood clots, or stroke which can be fatal. This risk increases with age and the number of cigarettes smoked.
The use of a CHC, like the birth control ring, is associated with increased risks of several serious side effects, including blood clots, stroke, or heart attack. NuvaRing is not for women with a history of these conditions or any condition that makes your blood more likely to clot. The risk of getting blood clots may be greater with the type of progestin in the ring than with some other progestins in certain low-dose birth control pills. The risk of blood clots is highest when you first start using CHCs and when you restart the same or different CHC after not using it for a month or more.
The ring is also not for women with high blood pressure that medicine can’t control; diabetes with kidney, eye, nerve, or blood vessel damage; certain kinds of severe migraine headaches; liver disease or liver tumors; take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, as this may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood; unexplained vaginal bleeding; breast cancer or any cancer that is sensitive to female hormones; or if you are or may be pregnant.
The ring does not protect against HIV infection (AIDS) and other sexually transmitted infections.
The most common side effects reported by users of the ring are irritation inside your vagina or on your cervix; headache (including migraine); mood changes (including depression); the ring slipping out or causing discomfort; nausea and vomiting; vaginal discharge; weight gain; vaginal discomfort; breast pain, discomfort, or tenderness; painful menstrual periods; abdominal pain; acne; and less sexual desire.