A wealth of choices for birth control exists today, and most women are able to find a method with which they are happy. The nonhormonal barrier/spermicide methods are mostly unchanged in recent decades. They include condoms (male andn female), spermicides such as foam and the Today sponge, and the diaphragm (which is worn inside the vagina). This last device requires a fitting in the office as well as a prescription for the proper size. While some women prefer these methods precisely because there are no hormones, they are somewhat less effective and are a bit more cumbersome to use, requiring placement and removal at specified times.
Pills – Hormonal birth control remains popular because of its greater than 99% effectiveness and ease of use. Pills have been available for over fifty years and come in dozens of different formulations, dosages and cycle schedules. To work their best, pills need to be taken on a daily basis, reasonably close to every 24 hours. In recent years, they have been joined by the Orth-Evra patch (changed weekly) and the NuvaRing vaginal ring (worn for three weeks on a four-week schedule).
Injections – If estrogen is a problem for a medical reason or particular side effect, several progesterone-only options are available. The Depo-Provera injection is the most popular of these because it is only needed every 12 weeks and usually stops menstrual periods altogether (a harmless and very nice side effect). The progestin can also be given by a daily pill or by the Nexplanon device placed under the skin of the upper arm.
Nexplanon – This device is a flexible plastic rod that contains a progesterone contraceptive. Once it is placed under the skin of the upper arm, the hormone is released slowly into the bloodstream. It maintains full effectiveness for three years. Although most patients have irregular to no periods, the majority do not find their bleeding pattern bothersome.
Both the placement and removal of Nexplanon are done quickly in the office with a little bit of local anesthetic and a small puncture. Dr. Roberts is trained and certified by the manufacturer of Nexplanon, which is required in order to obtain the device. In addition, she has experience with Norplant, which was the forerunner to Nexplanon and was considerably more difficult to handle.
IUDs – Three different intrauterine devices (IUDs) are available and are about 98% to 99% effective. Each is shaped like a “T” and is placed inside the uterus with the attached string coming down through the cervix to where it can be seen and felt in the upper vagina. The Paraguard contains a copper “sleeve” on each arm and lasts for ten years. Both the Mirena and Kyleena are plastic intrauterine devices that contain a progesterone hormone. Once in place inside the cavity of the uterus, they gradually release tiny amounts of the hormone. This progestin works locally inside the uterus and is not found in any significant amounts in the bloodstream.
It has been shown that these IUDs work mainly by preventing the ability of the sperm to fertilize the egg. In addition the progesterone makes the uterine lining thinner, which lightens the periods considerably and sometimes causes them to disappear. This benefit is even useful for women who do not need contraception but suffer from heavy menstrual bleeding.
The Mirena is good for five years. Kyleena is smaller and designed for the uterus of a woman who has not had any babies; and it is also approved for five years.
Dr. Roberts will be happy to review your contraceptive choices and preferences with you. She understands that it may take several tries for you to settle on what works best.
Our family planning patients come to us from Apex, Holly Springs, Wake Forest, Raleigh and Cary, near Brier Creek in Wake County, NC. Call Dr. Lee Ann Roberts at 919.881.7766 today or use our Request an Appointment form to schedule your consultation with us.