What Doctors Suggest For Women Who Don’t Want IUDs
With Donald Trump as the president-elect of the United States, you may wonder what that means for you and your birth control. You may have seen flocks of women take to Twitter and post that now’s the time to get an IUD (aka an intrauterine device), which can last anywhere from three to 12 years. But what are birth control options for women who don’t want IUDs? “Some women find the idea of a procedure to insert a method unacceptable, preferring methods that are shorter-term or within their control,” Kelly Culwell MD, MPH, and Chief Medical Officer at WomanCare Global, tells Bustle. “Others prefer to avoid hormonal contraception option (like pills, patches and rings) because of health concerns or side effects.”
Like all methods of birth control, there’s no one-size-fits-all solution. And before Trump is sworn in on January 20, 2017, many women are trying to determine the best birth control for them, hopefully one that’ll last throughout Trump’s four-year term, perhaps longer. As you probably know, Trump and our soon-to-be vice-president, Mike Pence, aren’t fans of the Affordable Care Act (aka Obamacare) and have not been shy about vocalizing that they’d like to get rid of it. Millions of women get their birth control paid for via Obamacare and, as you know, it’s often not cheap.
It's also possible that Trump and Pence will try to defund Planned Parenthood. “Things will not change overnight, and there will be healthcare professionals to help and take care of women irrespective of the changes with the Affordable Care Act or if Planned Parenthood is defunded,” Dr. Michael Krychman, Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine and co-author of The Sexual Spark: 20 Essential Exercises to Reignite the Passion, tells Bustle.
So what’s an anti-IUD female to do if she wants to find a long-term birth control method? According to the Guttmacher Institute, The Pill and female sterilization have been the two most commonly used birth control methods — since 1982.
But, of course, talking to your OB/GYN is key to determining the right birth control method for you. Here are 8 birth control options to consider if you don’t want an IUD.
Yep, condoms, the good old safe-sex standby. Plus, they help prevent STIs and STDs, unlike several other birth control methods. I know, I know — your partner hates using condoms, right? Try Trojan BareSkin, SKYN, or ONE condoms which aim to feel nearly invisible. “I would recommend that women try to stockpile condoms — they have long-term expiration dates,” says Dr. Krychman. Plus, you can buy them virtually anywhere and often get them for FREE from clinics (like Planned Parenthood).
When used correctly, condoms are 98 percent effective. But that goes down to 82 percent for “typical use” when little mistakes are made, like an expired or torn condom. “Barrier methods, including the diaphragm and condoms, are not as reliable in preventing pregnancy,” Sherry Ross, MD, OB/GYN and Women’s Health Expert, tells Bustle. “But they are alternatives for those women who are sensitive to the hormonal effects of other birth control options.”
An implant is an ideal method of birth control if you want something more long-term than birth control pills (see #3), yet not as permanent as sterilization (see #8). Progesterone arm implants, which come under the brand names of Implanon and Nexplanon, last for three years. A friend of mine has one and swears by it, though I know there’s no one perfect birth control method for everybody. (But wouldn’t that be ah-mazing?)
“Thousands of panicking women are calling their gynecologist to see if they can get long-acting birth control, including the IUD and progesterone arm implants, to carry them through Trump’s presidency,” says Dr. Ross. “The wonderful thing about the birth control implant is that it protects you from getting pregnant for three years without having to ingest a pill every day.”
When you get the implant, a thin, plastic matchstick-sized rod is inserted into your arm. It then releases the hormone progestin. And, good news: It can be used by women who cannot take estrogen. The implant then keeps eggs from leaving the ovaries (technology, huh?); hence, there’s no egg to get together with sperm. As for effectiveness, less than one out of 100 women will become pregnant when using an implant, according to Planned Parenthood.
“The big negative side effect of nexplanon is that some women experience irregular, long periods that are inconvenient enough to want it removed,” Sarah Yamaguchi, MD, OB/GYN at Good Samaritan Hospital in Los Angeles, CA, tells Bustle.
3. Birth Control Pills
Some insurance companies may only allow you to get one pack of birth control pills at once. But others allow you to get several months’ or a year’s worth, which should at least help you for a while before Trump’s new healthcare policies kick in.“Oral contraception, or The Pill, is still the most popular method of birth control in the United States,” says Dr. Ross. “For many, it’s a girl’s best friend! In addition to being a great form of birth control, the pill can help women who have disruptive and horrible cramping and heavy bleeding during their period.”
Dr. Beth Davis, OB/GYN, Baylor Obstetrics and Gynecology at Texas Children’s Pavilion for Women in Houston, agrees. “In addition to regulation of cycles, pills have many other advantages,” she says. For instance, “They are protective against ovarian and endometrial cancer and can be used to reduce ovarian cyst production.” Of course, some women have bad side effects from The Pill, like mood swings and nausea, so it’s not even an option. Or, they smoke or have a history of blood clots or breast cancer, so they are not candidates for it.
“There is a failure rate with birth control pills,” Dr. Lauren F. Streicher, MD, Clinical Associate Professor of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, tells Bustle. “It’s 0.1 percent if perfect, but the typical failure rate is 7-8 percent. User-dependent methods [like the Pill] are most likely to have failure rates.” So, like anything else, the instructions need to be followed.
“If you don’t want to take a daily pill orally, you can use the NuvaRing,” says Dr. Ross. “It’s a vaginal ring you leave in the vagina for three weeks to prevent pregnancy.” Dr. Krychman agrees. “NuvaRing is a good contraceptive for those who do not want long-acting contraception,” he says. “It’s worry-free and easy to use.”
When used correctly, it can be 98 percent effective. However, that percentage goes down if there’s user error. “Besides IUDs and Nexplanon, there is the pill, the patch, NuvaRing, the diaphragm, and condoms,” says Dr. Yamaguchi says. “But the latter methods have user error, so they are more likely to fail.”
Some of the side effects from using a NuvaRing mirror ones from other methods of hormonal birth control. You may experience things like nausea and bleeding between periods. Some studies are also finding that NuvaRing increases the risk of blood clots.
5. The Patch
What is it? “A once weekly patch that contains both estrogen and progesterone,” says Dr. Davis. “Also, more than 90 percent effective. It’s another alternative to pills, with the same risks, benefits, and side effects.”
As you may know, it’s a beige-colored square patch that you wear on your skin. The hormones in it prevent your ovaries from releasing an egg, as well as thicken cervical mucus to help keep sperm from reaching the egg. “The Patch is easy to use; it’s like sticking on a Band-Aid,” Dr. Draion M. Burch, OB/GYN and Astroglide TTC Sexual Health Advisor, tells Bustle. “But, it can cause irritation where the patch sits on your skin.”
Though, not everyone recommends it to their patients. “The patch is fine, but not my first choice, given some emerging concerns regarding blood clots,” says Dr. Krychman. “But if you’re on it and doing well, I would continue you on it.”
6. Depo-Provera (Contraceptive Injection)
This is “a progesterone-only injection given once every three months in the office that is approximately 94 percent effective,” says Dr. Davis. “It is a great option for people who have difficulty remembering a daily medication.”
What does the Depo injection do? Keeps ovaries from releasing an egg. Like the patch, it thickens cervical mucus to keep sperm from getting to the egg. In addition, “The injection tends to make periods disappear over time, which means it can also be used to treat patients with heavy and/or painful periods,” says Dr. Davis. “Patients who have problems with fibroids or endometriosis often benefit from the Depo shot.” However, your OB/GYN will help determine if it is right for you, as it may not be if you have a history of depression or are sensitive to any components of the shot, for example.
7. Fertility Awareness Method, aka The Rhythm Method
“The natural family planning, or fertility awareness method, relies on regular cycles to determine timing of ovulation, avoiding unprotected intercourse during the ‘fertile window’ of a menstrual cycle,” says Dr. Davis. “It requires the patient to be very in tune to her body, and a partner who is willing to comply with use of a barrier method or avoiding intercourse around the time of ovulation.”
A key component to this birth control method? “You have to have self-control,” says Dr. Drai. Dr. Ross agrees. “It’s a non-hormonal option with the high chance of accidentally getting pregnant.”
When women talk about getting their tubes tied, here’s the DL: Their fallopian tubes are closed or blocked. If they’re tied or cut, it’s a tubal ligation. Another method is known as Essure (aka transcervical sterilization), a non-hormonal and non-surgical procedure, wherein tiny inserts are put in the tubes and the scar tissue that grows around them ends up blocking the tubes. It’s over 99 percent effective. However, side effects can range from cramping to vaginal bleeding, with chronic pelvic pain as a longer-term risk.
“Women have always taken the lead when it comes to birth control, and permanent sterilization is no different — 27 percent of women get a tubal ligation, while only nine percent of men get vasectomies,” says Dr. Ross. “I would love to see more men taking charge of this permanent sterilization process. After all, a vasectomy is a less costly, faster, shorter recovery, and safer office procedure, while a tubal ligation involves general anesthesia, a longer surgical procedure and recovery, and is more costly.”
Dr. Yamaguchi agrees, saying, “vasectomies are safer than laparoscopic tubal ligations, so I recommend that. I think [female] sterilization has its place, but I usually recommend avoiding surgery if possible. It’s one thing to do a tubal ligation at the time of a cesarean section, but I think it’s another thing to take a patient for a laparoscopic tubal ligation as a separate surgery when there are things like IUDs available.”
All in all, Dr. Drai says the pro about sterilization is, “It’s permanent.” And the con is, “It’s permanent.”
As you can see, there are plenty of other birth control options aside from IUDs. Whatever birth control method you (and your OB/GYN) choose, just remember that we’re all in this together.
“The first thing I would tell my patients is not to panic,” Dr. Ross says. “Even though the cost of birth control can be hard on a women’s monthly budget, you still want to use the birth control method that is most effective in preventing pregnancy and doesn’t cause a lot of side effects; you must choose what method works best for you.”
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