Birth Control in 2021: There’s One New Option

It has been a long time since I had to think about birth control. I had my tubes tied during the birth of my twins 11 years ago, both because 5 kids was enough for me, and because my doctor, who is my friend, told me she would stop speaking to me if I got pregnant again. Because I had some complications, a fifth C-section posed a significant threat. I was also on the pill because I lost my mom to ovarian cancer, and the pill is thought to minimize the risk. On top of this, with two newborns to nurse, I was actively practicing abstinence most nights of the week. Still, almost every month, I convinced myself I was pregnant. Are my boobs sore? Does this wine taste funny? Is that gas or a flutter? If you are a sexually active woman, you probably know what I mean. In my reproductive life, I’ve both prayed for one line and prayed for two, and both are stress inducing. Having a hysterectomy two years ago permanently put all the demons to rest, and sex, for sex’s sake, without risk of pregnancy, is a beautiful thing.

Many of you may have lots of reproductive years ahead. There is so much to consider when you are choosing birth control — ease, efficacy, side effects (both short and long term,) your reproductive plans for the future, how many partners you have, etc. You also need to see how much you relate to the frolicking women in the commercials. Will that contraception choice make you feel free enough to break out in song in the middle of the street?

Here is a quick comparison, simply so you can be reminded of and see your options. Most importantly, speak with your doctor, and let him or her guide you, but it is great to go into the appointment well-informed, with a sense of what will make sense for you.

FIRST, THE CLASSICS

• SPERMACIDE
Bottom line here, unless you are using with another form of BC, don’t do it. They are messy, irritating, may increase likelihood of STDs, and only about 70% effective after a year of use.

• CONDOMS
Upside: Protect against STDs (STDs btw are on the rise) and inexpensive. Effective 98% of the time when used correctly.

Downside: Depends on the man to use correctly every time, and likely because of that, about 15% of couples who use condoms exclusively get pregnant in the year. Also, they may affect spontaneity and irritate the skin.

• FEMALE CONDOMS
Honestly, don’t bother. While they can be inserted up to eight hours before sex and offer some protection against STDs, they are loud and messy and only about 80% effective.

• DIAPHRAGM
Upside: The woman is in control, they can be inserted up to 2 hours before sex, and they are inexpensive. When used perfectly, they are about 94% effective. For real imperfect people, they are about 88% effective.

Downside: They are available only by prescription, as you have to be fitted. They should be left in for 6 hours after sex, but not more than 24. They do not protect against sexually transmitted disease.

• OCP (oral contraceptive pills)
Upside: For many women, the pill is a life saver. When used perfectly (again, perfect is a hard standard), it is 99% effective. For most women who forget to take sometimes, it is about 91% effective. It can reduce PMS symptoms, usually decreases bleeding during periods, regulates the menstrual cycle and helps with acne. In some women, periods stop altogether on certain doses.

Downside: It does not protect against STDs. Because it is hormonal, it can cause mood changes and bloating in some women, and it has to be taken at the same time every day to achieve maximum effectiveness.

• HORMONAL IUD
Upside: It is not something you have to remember and it takes the man out of the equation. It may help with heavy periods and cramping, and it stays inserted for up to seven years, depending on the brand. If you want to become pregnant, after removal, you can start trying after your first cycle. It is over 99% effective.

Downside: It does not protect against STDs, and it can only be inserted and removed by a health professional. Some cramping is normal during and after insertion. It is expensive, but over time is one of the most cost effective methods.

Other hormonal birth control options dispense hormones to your body similar to those you get from the pill, so the effectiveness and the side effects are similar. The patch only has to be changed once a week and the ring, which you insert into your vagina, has to be changed once a month. The shot is given to you by your doctor every 12 weeks and the implant gets inserted under the skin and is effective for up to four years. All hormonal birth control methods increase your risk for blood clots and can affect your mood, appetite, skin and propensity for headaches.

• COPPER IUD (no hormones)
Upside: Is effective for 10 years, and there are no hormonal side effects. It is over 99% effective.

Downside: It can have the side effects of irregular and heavy bleeding as well as cramping. In the small chance you do get pregnant, you have a higher chance of an ectopic pregnancy. It does not protect against STDs.

Now, the NEWEST OPTION, approved by the FDA this past year.

PHEXXI – A gel that you insert into the vagina with pre-filled applicators
Upside: Non-hormonal, about as effective as condoms, can be used with other forms of BC to increase effectiveness

Downside: Needs to be inserted before sex, does not protect agains STDs, and may irritate some women. It is also pricey at about $21 a pop.

If we wait long enough, perhaps there will be a perfect option, one that doesn’t interfere with foreplay, protects against STDs, is reasonably priced, is effective and has no side effects. For now, the only thing that fits that bill is abstaining from vaginal sex or permanent sterilization. If you want birth control now, but want children in the future, consider a combination of methods that work for you, and be sure to protect yourself against STDs. If you have already had your family, or don’t want children, talk with your doctor about something more permanent. Life is stressful enough without having to worry about a middle-aged, unwanted pregnancy. On top of that, sex gets better when reproduction isn’t a concern!

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