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From condoms to oral contraceptives (i.e. birth control pills) to intrauterine devices (IUD) and birth control shots, women have a lot of choices when it comes to contraceptives. Of course, with so many to choose from, knowing which one to choose can be difficult.
“It is a pretty in-depth discussion when it comes to choosing the right option re: contraceptives,” says Dr Leo Walker, Obstetrician Gynaecologist (OBGYN). There are several factors to consider:
1) Your Medical History
As Consultant OBGYN Professor Horace Fletcher explains, if you suffer from certain conditions, your doctor may advise you to avoid some contraceptives. For example, “If you have ever had a stroke, heart attack, deep vein thrombosis or have hypertension, diabetes or breast cancer, all of these have been shown to be contraindicated to hormonal contraceptives.” As such, popular contraceptive methods, like the pill or birth control patch, are not advisable for these women. On the other hand, “for women who have fibroids or heavy periods,” says Dr Walker, “the hormonal IUD is excellent for reducing menstrual blood loss and fibroid size over a 5-year period.”
Certain chronic conditions, like a bleeding disorder, make getting pregnant and giving birth life-threatening. For such women, tubal ligation may be considered “if the condition is associated with a high risk of maternal mortality,” notes Dr Leslie Chin, OBGYN. You may also want to consider tubal ligation if you are at risk of being a carrier of a specific gene mutation (BRCA) associated with ovarian cancer.
2) Your Period
Professor Fletcher notes that women need the kind of period a woman has can also impact the decision. “If you have irregular periods, oral contraceptives can regulate your cycle.” He notes both the pill and hormonal IUDs can also help with period pain. However, “if you have a painful period “, copper IUDs, which do not release hormones, should be avoided” due to the potential side effects.
3) Potential Side Effects
Copper IUDs, for example, may cause bleeding between periods and severe period cramps, pain and heavy bleeding. Women already facing these issues are therefore advised to avoid them. Further, says Dr Walker, “an implant or injectables are not without disadvantages, as they can cause weight gain and irregular bleeding or spotting.”
4) Your Lifestyle and Habits
If you smoke, for instance, taking oral contraceptives can increase your risk of a heart attack. Women who smoke and are over 35 are also more at risk for complications from a hormonal IUD. Your sex life can also play a part. If you have a regular sex partner (and know their status), a LARC can also take some worry out of intimate moments if you don’t wish to get pregnant. However, if you have more than one sexual partner or casual sex, combining a LARC with condoms may be recommended to ensure you are protected from unwanted pregnancies and sexually transmitted infections.
5) Your Reproductive Plans (or lack thereof)
From Professor Fletcher, “women who are trying for a baby should, obviously, avoid all contraceptives.” Otherwise, your options are dependent on when, if ever, you plan to have children. For example, if you wish to have children soon, Dr Walker explains, “you may choose a short-term option like the combined oral contraceptive pill.”
If you plan to wait a while, a LARC may be a better option due to how long they last and how effective they are. “Intrauterine devices, for example,” Dr Walker says, “are effective for 5-10 years depending on which device is chosen.” Copper and hormonal IUDs are over 99% effective at preventing pregnancy, but once removed, should not impact your ability to get pregnant.
If you are over 40, already have children and don’t wish to have any more or don’t want any, Professor Fletcher notes a ‘permanent’ solution like tubal ligation (or vasectomies for men) is an excellent option to consider. It’s important to note that while it is reversible, your chances of getting pregnant are significantly lower. As such, if you are younger than 40, your doctor may advise you to get a LARC, even if you are sure you do not want children. As Dr Robyn Khemlani, OBGYN, explains, “LARCs’ effectiveness against pregnancy is the same as tubal ligation.”
6) Age
Depending on how old you are, this can impact the contraceptive options available to you. “For example,” Dr Khemlani says, “the Depo injection may affect the bone mineral density, so you wouldn’t offer it to a teen whose bones are still developing.” Professor Fletcher notes that women with osteoporosis (most common in women over 50) should also avoid the drug due to their low bone density.
Additionally, for younger patients, Dr Khemlani and Dr Leslie Chin, OBGYN, recommend options that require minimal user dependence, “i.e., something they don’t have to remember to take every day or think about using,” says Dr Chin. “Normally, I give them an implant or intrauterine device.”
Another example of age-impacting decisions is that hormonal contraceptives are typically avoided for women over 40 years. Professor Fletcher noted that this is especially true when they’re close to menopause, as these contraceptives can mask symptoms of approaching menopause.
7) Your Preferences
Contraceptive choices tend to vary widely from one individual to the next. Don’t want to have to remember to take a pill every day? Long-acting reversible contraceptives (LARCs), like IUDs, may be optimal, says Dr Walker. “As the name suggests, they are long-acting and don’t require daily dosing and are highly effective.”
Suppose you don’t like the idea of inserting a device into the uterus. In that case, Professor Fletcher notes that implants may be a good option for you as “they’re easy to implant, easy to remove (and so reversible) and highly effective.”
Ultimately, the choice is primarily up to the patient. Dr Walker explains, “the key is choosing an option that works for you, which largely translates into choosing what you are comfortable with.”
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