Know your birth control options | health rhythm

It’s important to ask questions about the many birth control options available now, so you can find something that fits your needs. (For Spectrum Health Beat)

Attention ladies: Has it been a while since you talked to your doctor about the best birth control option for you?

It may be time to change that.

A woman’s birth control needs change throughout her life, and new options are always available, including several in the last five years.

“We have many safe and effective birth control options,” said Suzanne West, MD, an obstetrics and gynecology specialist at Spectrum Health.

It’s important to start any conversation about birth control with important questions first, Dr. West said.

“We can start by talking about your period,” he said. “Is it painful or heavy? Would you like to improve your periods and also prevent pregnancy? That will take us down a path of options.”

Other things to consider:

  • Do you have a preference for hormonal or non-hormonal birth control methods?
  • Are you good at remembering to take a pill every day?
  • How often do you need contraception?
  • 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 method of birth control, approved by the Food and Drug Administration in May 2020. Since then, however, Dr. West said no patients have asked for it directly.

It is a prescription vaginal gel that prevents pregnancy. You put it in your vagina within an hour before sex. It lowers the pH in the vagina, which reduces sperm motility and helps prevent sperm from reaching the egg.

Before Phexxi, a similar over-the-counter option was also available, Dr. West said. Compared to that, Phexxi is less irritating and also has the benefit of reducing the risk of sexually transmitted infections, chlamydia, and gonorrhea.

2. Annovera contraceptive vaginal ring

Launched 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 doesn’t have to be refrigerated when not in use.

The patient inserts the soft silicone ring into the vagina and leaves it in for 21 days, then removes it for seven days.

3. Slynd’s Progestin-Only Pill

Slynd entered the birth control scene in 2019 and offered another progestin-only birth control pill, Dr. West said. (Before that, there was only one option.) While most birth control pills are combination pills containing estrogen and progestin, not all women can take estrogen, he said.

Dr. West said this pill is also advantageous because it has a longer “missed pill” window than other options, up to 24 hours. He also said that it is the only oral progesterone that reliably suppresses ovulation.

4. Twirla Contraceptive Patch

Approved in 2020, Twirla is a weekly contraceptive patch that contains a slightly different combination of hormones than other patches, making it an excellent option for people who have not tolerated previous patch formulations well, said Dr. West.

It is not an option for women with a body mass index greater than 30, and may 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 each annual exam.

“When I see people for their annual physical, I always ask if they are sexually active and if they need birth control,” she said. “If they do, what are they wearing? Are you happy with that method?

By far the most popular method among his patients is the flush-free progesterone intrauterine device, or IUD. Depending on which one you choose, they’re FDA-approved to stay in the body for up to seven years, Dr. West said.

In the past, IUDs have been linked to increased rates of pelvic inflammatory disease, due to the IUD’s braided string, he said.

But the IUDs used today have a monofilament thread, and most actually reduce a person’s risk of developing pelvic inflammatory disease once the IUD has been in place for at least two weeks.

Current IUDs have also not been linked to infertility and are offered to women who have never been pregnant, as well as young adolescents.

The Liletta IUD, one of the progesterone-containing IUDs, is the most widely 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. In addition, fertility returns immediately at the time of removal, said Dr. West.

Dr. West inserts the patient’s IUD in her office. It is a flexible plastic T-shaped device that, when inserted into 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,” he said.

Whichever 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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