Birth Control Q&A

Maureen Robb's picture
By Maureen Robb on August 6, 2018

When it comes to birth control, we’ve never had so many choices. But having so many choices can also make it difficult to know which is the best option for you.

Should you take the pill or use a sponge or the patch? Would you be better off with an implant, a shot or a vaginal ring? 

We asked Jaclyn Nunziato, M.D., with Carilion Clinic Obstetrics and Gynecology, to answer some common questions about birth control today. 

Living: What are some of the most popular types of birth control available now?
 
Dr. Nunziato: There are many options available to women today, but overall there are two main categories of birth control: hormonal and non-hormonal.
 
Hormonal:

The most common hormonal option is monthly oral contraception pills (OCPs) or “the pill.”
 
Each type contains various amounts of estrogen and progesterone, allowing us to differentiate between the amount of each hormone we give throughout the month. Pills that have the same progesterone to estrogen ratio are called monophasic pills, and pills that differ each week are called triphasic.
 
Depending on the patient’s reason for starting birth control, we can also change the way we distribute the pills. For example, a patient can take them monthly or use as continuous packs.
 
Some women want to have better control of their cycles, to have less cycles or need to control cyst formation, so the pill can also be tailored to meet those individual needs and to help alleviate specific issues.
 
Although oral contraception pills are a great option for first-line treatment, we have found that some patients (especially our younger patients) have trouble remembering to take the pill, so we do offer other alternatives such as the NuvaRing, which is placed inside the vagina, or the patch, which is placed directly on the skin.  
 
Long-Acting Birth Control
 
Long-acting forms of birth control known as long-acting reversible contraceptives (LARCS) have been revolutionary in the treatment of women over the last several decades and are quickly becoming a popular choice for woman of all ages.
 
There are several long-acting medications, including the progesterone-only, sub-dermal implant called Nexplanon, which is placed in the upper extremity through an in-office procedure.
 
Technically speaking, Nexplanon is the most effective form of birth control and is active for three years.
 
Depo-Provera is another long-acting option for patients who have trouble remembering to take their pill or who want a birth control option that does not contain estrogen.
 
Depo-Provera is an injection given in the office every three months, but it is important to remember that timing is imperative to ensure effectiveness. For our patients, we schedule visits in advance to make sure it is as effective as possible.  
 
A favorite among many gynecologists is the intrauterine device or an IUD. This is a progesterone-only device that is placed inside the uterus through an in-office procedure. The device works for up to five years, but there are current trials to increase the efficacy to seven years. 
 
In our office, we use the Mirena and Kyleena IUDs. Kyleena is a great option for patients who have not yet had children.  
 
Non-Hormonal:
 
There are also several non-hormonal types of birth control available for patients, including spermicide, diaphragms, sponges, cervical caps, female and male condoms and an IUD called the Paraguard.
 
These are great options for women who are extremely sensitive to local or systemic hormonal control.

If you are done having children, a vasectomy for your partner is a safe and an effective way to prevent any further pregnancies. Procedures such as tubal ligations (tubes tied) are a permanent option for most women and should be discussed with your gynecologist.
 
It is also important to note that we recommend that all patients use condoms in conjunction with birth control to help reduce their risk of contracting an STD.  And when it comes to talking about birth control with teens, we always discuss abstinence as an option.
 
Living: What is the effectiveness as well as the advantages and disadvantages of the options above?
 
Dr. Nunziato: The advantages and effectiveness of the options above can differ depending on each woman’s unique needs.
 
I recommend setting up a separate appointment with your gynecologist to discuss your best birth control options. Myself and my fellow gynecologists at Carilion spend a great deal of time trying to tailor birth control to fit a patient’s symptoms, desires and long-term goals.
 
For example, if a patient has trouble remembering to take their pills on a daily basis, but she would like to get pregnant in the next three years, the IUD is a wonderful option because it does not block ovulation and the removal time to pregnancy time is much shorter than some other forms of birth control.
 
We also often talk in terms of perfect use efficacy versus practical use efficacy, so it is an important conversation to have with your gynecologist.

If a patient desires birth control pills but forgets to take the pills two to three times a week, besides facing unwanted side effects, the ability for the birth control to block fertilization or control your cycle is much lower.
 
I always counsel patients to keep in mind that there are side effects and limitations to every form of medication on the market and certain options can affect each individual patient differently.
 
Living: Is long-term birth control a healthy option?
 
Dr. Nunziato: Long-term birth control is a wonderful option for women who do not desire fertility within the next one to two years. It is also a wonderful option for patients who have trouble remembering to take a daily pill.
 
We often use long-acting birth control for patients who do not desire fertility in their 40’s and/or who would like to be bridged to menopause.
 
Living: Which options are suitable for which women?
 
Dr. Nunziato: Chronic and congenital medical conditions often play a role in determining which birth control is the best option.
 
There are many contraindications to starting birth control and it’s important to start any type of birth control under doctor supervision with close follow up.
 
For example, we often switch patients over from combined oral contraceptives to progesterone only pills if they are over 35 years old with a significant smoking history because we are concerned about the potential for blood clot formations.
 
If you have a chronic medical condition, it is extremely important to notify your doctor before you start any medication.
 
Overall, finding the best birth control option to meet your individual needs requires extensive conversation and evaluation with your gynecologist.
 
 
Living: What advice in general would you give a woman who is trying to choose a birth control method?
 
Dr. Nunziato: My best advice is to schedule an appointment with your doctor. These office visits are often my favorite visits because it’s worth the conversation and can really make an impact on your quality of life, future planning and symptomatic control. 
 
Birth control options are tailored to the individual and can be adjusted accordingly, so keep an open mind and explore all of your options.