Attention ladies: Has it been a while since you talked to your doctor about the best birth control option for you?
It might be time to change that.
A woman’s birth control needs change throughout her life, and there are always new options available, including several in the last five years.
“We have lots of birth control options that are safe and effective,” said Suzanne West, MD, a Spectrum Health obstetrics and gynecology specialist.
It’s important to start any conversation about birth control with big questions first, Dr. West said.
“We can start by talking about your period,” she said. “Is it painful or heavy? Would you like to make your periods better and also prevent pregnancy? That will lead us down a path of options.”
Other things to consider:
- Do you have a preference for hormonal or non-hormonal birth control?
- Are you good about remembering to take a pill every day?
- How frequently do you need birth control?
- Do you have health insurance or budget constraints to consider?
- What health conditions do you have?
The list of birth control options is long, but there are four new methods—available in the last five years—to add to the possibilities, Dr. West said.
1. Phexxi contraceptive gel
This is a new non-hormonal birth control method, approved by the Food and Drug Administration in May 2020. Since then, though, Dr. West said she has not had any patients directly ask for it.
It’s a prescription vaginal gel that prevents pregnancy. You place it in your vagina within an hour before sex. It lowers the pH in your vagina, thus reducing sperm mobility and helping to stop the sperm from getting to an egg.
Before Phexxi, there was also a similar over-the-counter option available, Dr. West said. Compared to that, Phexxi is less irritating and it also carries the benefit of reducing the risk of contracting the sexually transmitted infections chlamydia and gonorrhea.
2. Annovera contraceptive vaginal ring
Released in 2018, this vaginal ring has advantages over similar products because the same ring can be used for a full year—or 13 menstrual cycles—and it does not have to be refrigerated when not in use.
The patient inserts the soft, silicone ring into the vagina and leaves it for 21 days, then removes it for seven days.
3. Slynd progestin-only pill
Slynd came on the birth control scene in 2019, offering another progestin-only birth control pill, Dr. West said. (Prior to that, there was only one option.) While most birth control pills are combination pills containing estrogen and progestin, not all women can take estrogen, she said.
Dr. West said this pill is also advantageous because it has a longer “missed-pill” window than other options—up to 24 hours. She also said it is the only oral progesterone that reliably suppresses ovulation.
4. Twirla contraceptive patch
Approved in 2020, Twirla is a weekly birth control patch that contains a slightly different hormone combination than other patches, thus making it a great option for people who haven’t tolerated previous patch formulations well, Dr. West said.
It is not an option for women with a body mass index higher than 30, and can be less effective in women with a BMI between 25 and 30.
With new options and ever-changing circumstances in a woman’s life, Dr. West recommends discussing birth control at every annual exam.
“When I see people for their yearly physical, I always ask if they are sexually active, and do they need birth control,” she said. “If they do, what are they using and are they happy with that method?”
By far the most popular method among her patients is the leave-in progesterone intrauterine devices, or IUDs. Depending on which one you choose, they are FDA-approved to remain in the body for up to seven years, Dr. West said.
In the past, IUDs were linked to increasing rates of pelvic inflammatory disease, due to the braided IUD string, she said.
But the IUDs used today have a monofilament string—and most actually decrease a person’s risk of developing pelvic inflammatory disease once the IUD has been in for at least two weeks.
Current IUDs also have not been linked to infertility and are offered to women who have never been pregnant, as well as young teens.
The Liletta IUD, one of the progesterone-containing IUDs, is the most commonly used IUD at Spectrum Health, Dr. West said.
Patients like it not only because it is FDA-approved to prevent pregnancy for up to six years, but it also helps women control or eliminate their period. Also, fertility returns immediately at time of removal, Dr. West said.
Dr. West inserts the IUD in the patient in her office. It’s a flexible, plastic, T-shaped device that when inserted in the uterus releases a progestin hormone that prevents pregnancy by inhibiting sperm movement, reducing sperm survival and thinning the lining of the uterus.
“It’s very well-tolerated,” she said.
Whatever option is right for you, don’t be afraid to ask questions and explore alternatives with your doctor at any stage.
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