Some of the most commonly used methods of birth control are hormonal. However, there are 2 different types of hormonal birth control- combined (containing estrogen and progesterone) and progestin-only. Both types are equally effective when used properly, but they each have their own advantages and disadvantages. The types of progestin-only birth control are the pill (mini-pill), the shot (called Depo-Provera), implant (Implanon), and IUD (Mirena).

Progestin methods are often used in women that can’t take estrogen due to certain medical conditions. People who have had blood clots, pulmonary embolism, or deep vein thrombosis should not take estrogen-containing birth control. People prone to these conditions should also not use estrogen-containing birth control. The same goes for people with uncontrolled high blood pressure, smokers >35y/o, and people with migraine headaches with an aura. People who are breastfeeding usually prefer progestin-only birth control because estrogen-containing birth control can decrease their milk supply.

The most common side effect of this type of birth control is irregular bleeding. People may experience bleeding in between periods, irregular spotting throughout their cycle, or they may stop getting a period all together. People may also experience headaches, nausea, breast tenderness, or weight gain. The progestin can increase your appetite, so although the medication itself does not cause weight gain if you are hungrier you may eat more and this can lead to weight gain. Depo-Provera most commonly causes weight gain as compared to the other methods discussed here.

The progestin-only pill, or mini-pill, is a pill that is taken daily. It is important to take the pill at the exact time every day, because even a delay as little as three hours can lower the efficacy of the pill. When starting the pill you should use a back-up method of birth control for the 1st week. The same should be done if a pill is missed. If used perfectly the failure rate is about 0.3%. Along with irregular bleeding, which is the most common side effect, people may also tend to develop ovarian cysts. This medication may not be effective if used in combination with certain anti-seizure medications.

Another type of progestin-only birth control is an injection called Depo-Provera. It is an injection that is given about every 12 weeks. This injection should be given ideally during the 1st 5 days of your period. In people that are breastfeeding the shot can be given during the post partum period, and it can even be given immediately after delivery. Again the most common side effect is irregular bleeding. Many people will stop getting a period completely after several injections. It can take about 6 months or more to get a regular cycle back after stopping the injection. Depo-Provera can lead to reversible bone loss, especially if used for more than 2 years. This bone loss is reversible after discontinuation of the shot, but it is important to take in sufficient calcium and vitamin D while using the shot.

Another kind of progestin-only birth control is the implant, called Implanon. This is a small implant, about 2 x 4 cm, which is placed in the upper arm. It must be inserted and removed by a healthcare provider. It can be left in place for 3 years. It also can lead to irregular bleeding or absence of your period.

The Mirena IUD is a device that sits in the uterus for up to 5 years while slowly releasing progesterone. For more details on this refer to last months article on IUDs.

Remember that all of these methods are fairly reliable methods of birth control. They are also helpful in people who have heavy periods because it can cause them to become lighter or to stop all together. None of these protect against sexually transmitted diseases, however, so you should always use condoms if you are at risk of developing an STD. Check in next month when we’ll be discussing combined hormonal methods of birth control.

The intrauterine device (IUD) is one of the most effective forms of birth control. It is a small, T-shaped plastic device that is inserted and left inside the uterus to prevent pregnancy. The IUD can be used by women of all ages, including teenagers and those who have never had children. There are 2 types of IUDs available for insertion: the hormonal IUD (Mirena) and the copper IUD (Paraguard). The IUD mostly works by preventing fertilization, but it also interferes with implantation. Fertility is not affected by the use of the IUD. Return to fertility after removal of the IUD is similar to the rates after discontinuation of other forms of contraception, such as birth control pills.

The Mirena is an IUD that contains the hormone progestin. It slowly releases this hormone over 5 years. The Mirena IUD has more than just contraceptive benefits. It can also help women who have heavy periods. In fact, about 47% of women will have no period after three years of Mirena use. Even if your cycle doesn’t go away completely, the majority of women will still at least experience shorter and lighter cycles. The Mirena IUD should be placed within seven days of your menstrual cycle, but can be placed at any time during your cycle. The Mirena can be placed immediately post partum, but there is a higher risk of expulsion or uterine perforation when it is placed at this time. It is safer to wait until at least 6 weeks post partum. The 5 year failure rate of the Mirena IUD is 0.7 pegnancies/100 women. However, if you do become pregnant while using the IUD make sure to consult your healthcare provider immediately because there is a higher risk of ectopic pregnancy, meaning that the pregnancy implants outside of the uterus, usually in the fallopian tubes.

Potential side effects of the Mirena IUD are irregular bleeding, especially for the first three to six months. Patients may rarely develop an infection of the pelvis, called Pelvic Inflammatory Disease. If you are prone to acne, the Mirena IUD can make it worse. There is a small chance that the IUD can migrate out of the uterus and into the abdominal or pelvic cavity. If this is the case, you might need a laparoscopic surgery to have the IUD removed.

The copper IUD (Paraguard) works the same way as the Mirena, but it is made of copper, doesn’t contain hormones, and is meant to stay in place for up to 10 years. The Paraguard can also be placed at any time of the cycle. The failure rate of the Paraguard is 0.6-0.8/100 women. As with the Mirena, although pregnancy is rare if you do become pregnant you may be at increased risk of having an ectopic pregnancy.

The main side effect of the Paraguard is heavier and longer menstrual cycles. However, the Paraguard IUD can be associated with a decreased incidence of endometrial cancer.

Remember that IUDs do not prevent against sexually transmitted infections and should not be placed if you are at high risk of developing or currently have a pelvic infection. They should also not be used if you have unexplained vaginal bleeding.

IUD are extremely effective methods of birth control. They should be considered in anyone who desires long term birth control but doesn’t want anything permanent. Once it is in place, you do not have to do anything else to prevent pregnancy. It does not interfere with sex or daily activities. You can use a tampon with it. It is easily reversible, and if you wish to become pregnant, simply have the IUD removed. The insertion of an IUD is a simple office procedure, so if you are interested in this type of birth control discuss it with your doctor and you can decide if it is the proper type of birth control for you.

For more information, email us here or call 732.431.1616.

Not sure which kind of contraception is best for you? No need to fret.

Part two of Dr. Julie Leizer’s series on the topic talks barrier methods:

Barrier methods of contraception are some of the safest methods of birth control. They work exactly as they sound: they act as a barrier between the sperm and the egg to prevent pregnancy. There are different types of barriers, chemical barriers and physical barriers. Chemical barriers are called spermicides. Physical barriers include condoms (both male and female), diaphragms, cervical caps, and sponges. This post is meant to give you a general overview of the different types of barrier methods of contraception and their effectiveness.

The Chemicals Between Us

Chemical methods of birth control, as mentioned earlier, are called spermicides. These are chemicals that are inserted directly into the vagina no more than 30 minutes before sex, and then should stay in for up to six to eight hours afterwards. They come in foams, creams, jellies and suppositories. Spermicides, if used alone, must be inserted before every time you have sex to be effective. The benefits of spermicides are that they are cheap, over-the-counter, and do not contain any hormones. The potential risks include allergic reactions and vaginitis, which is vaginal inflammation. Spermicides DO NOT protect against sexually transmitted diseases (STDs) such as gonorrhea, chlamydia, or HIV. In fact, if used frequently they can actually increase transmission of HIV if your partner is affected. With perfect use, the chance of pregnancy is low, but with typical use (meaning use by the average person, who may not always use them consistently or correctly), the pregnancy rate is 28%.

Let’s Get Physical

Physical barriers include male condoms, female condoms, diaphragms, cervical caps, and the sponge. Male condoms can be made of rubber (latex), plastic (polyurethane), or animal membrane. Latex and poly-urethane condoms provide the best available protection against many STDs, including HIV. Natural membrane condoms do not protect against STDs or HIV. Male condoms are more effective when used with spermicides. In fact when condoms and spermicides are used together, the efficacy is about the same as with hormonal methods of birth control. The spermicides should be placed directly into the vagina, not onto the condom. Water-based lubricants (KY jelly, for example) should be used with condoms to prevent breakage from friction. Oil based lubricants (such as baby oil) can weaken and break the condom. The benefits of condoms (much like spermicides) are that they are cheap, can be bought over-the-counter, and do not contain hormones. However, a new condom must be used each time you have sex. With perfect use failure rates are about 2%, but with typical use the failure rate is about 18%. A possible side effect is an allergic reaction.

The female condom is similar to the male condom in the way that it works. It is a plastic barrier with two rings, one that goes close to the cervix and the other stays outside of the vagina. It should also be used with spermicide as well as lubrication. The female condom can be put in place up to 8 hours prior to sex. Typical use failure rate is 21%, but with perfect use failure rates are about 1%.

The diaphragm is a latex or silicone, dome-shaped device that fits inside the vagina and covers the cervix. It is not effective unless it is used with spermicide, which needs to be reapplied each time you have sex. Like latex condoms, only water-based lubricants should be used because oil-based lubricants can weaken the latex. A diaphragm should be checked frequently for holes by holding it up to the light. Latex diaphragms should be replaced about every two years. Silicone diaphragms may last longer. The diaphragm does not protect against STDs, including HIV. A condom should be used with the diaphragm to prevent STDs. One thing that makes the diaphragm different from other barrier methods of birth control is that diaphragms require a prescription and need to be fitted by a health care provider. If you gain or lose 20 pounds or have a baby, you need to be refitted. You should wait 6 weeks after giving birth to use the diaphragm until the uterus and cervix return to normal size. The diaphragm must remain in place for six hours after sex but no more than 24 hours. It can be placed two hours before sex. If it is placed more than two hours before, you need to add more spermicide with an applicator. The benefits of diaphragms are that they don’t contain hormones. The potential risks are allergic reactions and possibly urinary tract infections if they are not fitted properly. With typical use, the failure rate is about 12%.

The sponge is a doughnut-shaped device made of soft foam coated with spermicide that gets inserted into the vagina to cover the cervix. The sponge does not protect against STDs, including HIV, so condoms should also be used to prevent STDs. Use some water to wet the sponge prior to insertion, which can be up to 24h before sex. It should be left in place for 6 hours afterwards. It can be left in place for up to 30 hours total, so if you had sex more than once in that time frame you don’t need to use a new sponge. With typical use, failure rates are 12-24%, depending on whether or not you have given birth (efficacy decreases if you have had a vaginal delivery). Failure rates with perfect use are about 9%. A benefit to the sponge is that they do not contain any hormones. They should not be used during your period or before 6 weeks post partum. However, potential risks include allergic reactions and a very small risk of developing toxic shock syndrome.

The cervical cap is similar to the diaphragm, but smaller. It is a small plastic dome that fits tightly over the cervix and stays in place by suction. The cervical cap, like the diaphragm, should be used with a spermicide. It also does not prevent STDs, so it should be used with condoms. A cervical cap must be fitted and prescribed by a health care provider. It must be checked frequently for wear or holes and should be replaced yearly. Refitting may be needed after having a baby or after weight gain or loss. You should wait six weeks after giving birth to use the cervical cap. The cervical cap, like the sponge, is less effective in women who have given birth. Typical use failure rates are 13 to 23%.

When used appropriately and consistently, barrier methods of birth control can be very effective. The benefits of these methods are that they are relatively inexpensive and they do not contain hormones. Many women cannot take hormones due to certain medical problems or they just don’t like the way that hormones make them feel. Barrier methods can provide a safe alternative for patients who are very motivated and are looking for alternative forms of birth control. Remember, all of these methods need to be used each time you have sex in order to be most effective. They all prevent against pregnancy, but remember the only ones that prevent against STDs are condoms. Therefore, even when using other barrier methods condoms should always be used if you feel that you are at risk of contracting an STD. Also, always check with your health care provider if you are unsure which method would be best for you.

Dr. Julie Leizer grew up in East Brunswick, NJ and received a Bachelor of Arts degree in Spanish from the University of Michigan in Ann Arbor, MI. She is fluent in Spanish, and specializes with our Spanish speaking patients. After completing her Medical degree, Dr. Leizer underwent four years of training in Obstetrics and Gynecology at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, in New Brunswick, NJ.