Birth Control Options

At The Woman’s Health Pavilion, we support a woman’s right to plan her family as she sees fit. This includes having access to a full range of birth control options at our OB/GYN offices in Queens and Long Island. Fortunately, many forms of safe and reliable contraception are available today, including the ones detailed on this page.

The Woman’s Health Pavilion offers a range of contraceptive solutions. To find the right one for you, request an appointment with a gynecologist or support staff at any of our Long Island locations. We see patients 7 days a week and offer same-day appointments for urgent conditions.

Common Methods of Birth Control

As gynecology specialists, we see many women who are interested in contraception. Because there are so many options available, it may be overwhelming to choose the right one. Our experienced staff is ready to walk you through your options and take the uncertainty out of this decision. To learn more about the following birth control methods, click on its name and you will jump to that section:

Birth Control Pills or “the Pill”

Birth control pills are a popular choice for women who need contraception. While the Pill does not prevent sexually transmitted infections, it is available in a range of formulations that can provide a variety of benefits. For the right candidates, the Pill offers not only safe and reliable contraception, but also light, regular periods with less cramps and fewer PMS symptoms, not to mention a reduced risk of ovarian and uterine cancer. Visit our Birth Control Pills page to learn more.

Women with Umbrellas

The Contraceptive Patch and Contraceptive Ring

Two forms of contraception are especially useful for women who would otherwise take the Pill, but who are unreliable with taking daily medication: Ortho-Evra (the contraceptive patch) and Nuvaring (the contraceptive ring). The patch is changed weekly (with one week off every month), and the ring is inserted vaginally and changed monthly (with three weeks in and one week out).

Both the contraceptive patch and the contraceptive ring work by releasing hormones into the bloodstream; the hormones are virtually identical to those found in birth control pills. As such, the risks and benefits are largely similar. Women using the patch, however, have 60% more estrogen released into their blood than they would if taking a typical birth control pill; there is some evidence that the risk of blood clots is thus higher in patch-users than in Pill-users. Also, the contraceptive efficacy of the Patch seems to be impaired in women who are very overweight: Women who weigh more than 198 pounds cannot rely on the contraceptive patch to prevent pregnancy.

Both the Patch and the Ring are especially useful for women who are not reliable daily pill-takers. As is the case with the Pill, they are not safe in women over 35 who smoke, in women with certain cardiovascular risk factors (e.g., uncontrolled diabetes or high blood pressure), and in women who have certain blood clotting disorders. If you are considering the ring or the patch, we would welcome the opportunity to review your options.

Depo-Provera

Depo-provera is an injectable form of contraception that is given every three months. Depo-provera is highly reliable: As long as women get their injection on time, the risk of pregnancy is less than 1%. This makes Depo-Provera a reasonable choice for women who don’t think they’ll be reliable with other forms of contraception.

In our practice, women are generally given a prescription for Depo-Provera to pick up at the pharmacy or to submit to their mail-order pharmacy benefit company. Once they have the injection, they return when they have their period so we can administer the injection in their upper arm or behind. (We want to be certain that you are not pregnant when you get your first injection, so it must be given during the first 5 days of your period.) To prevent pregnancy, it is important that the injection is given every 3 months. If women miss their scheduled injection, they will have to take alternate precautions to prevent pregnancy for a few weeks, and then return after a negative pregnancy test to get back on track.

Because Depo-Provera suppresses estrogen levels, prolonged use can adversely affect bone mineral density. This is especially important for young women: Generally, women “build” bone until their mid-20’s, and bone mass steadily deteriorates from that point onwards. There is some concern that long-term use of Depo-Provera results in a lesser “peak” bone mass, which could result in more osteoporotic fractures in women decades later. At present, this has not been proven, but it is known that long-term use of Depo-Provera decreases bone mass. Currently, the package labeling for Depo-Provera indicates that it should not be used for more than two years unless other contraceptive options are inadequate.

Importantly, women on Depo typically require several months after their last injection to return to full fertility: While the injection can be relied upon for 3 months of protection, women may find that it takes much longer for their monthly period to be re-established, and even longer to become pregnant. This makes Depo-Provera a poor choice for women who are planning to conceive quickly after discontinuing contraception.

As a rule, I don’t use Depo-Provera as a “first-line” option for most women. First, the adverse effects on bone mass are a significant consideration. Also, side effects are common, and they tend to be the type of side effects that many women find intolerable. In the first few months of use, most women using Depo-Provera will have disorganized periods. Usually, bleeding is not heavy, but periods may drag on, or there may be persistent light staining between periods. Weight gain is common with Depo-Provera: In one study, the average woman using Depo-Provera gained 5.4 pound after the first year of use. Hair loss has been reported in up to 10% of women. Additionally, women prone to depression may find that they are especially “blue” while using Depo-Provera. So, if you don’t mind gaining weight, losing hair, feeling blue, and bleeding persistently…Depo is right for you!

With Depo-Provera injections, after women “get over the hump” of the first 3 to 6 months, they get to enjoy the light, regular periods (or no periods at all) of Mirena or Skyla.

Seriously, though, Depo-Provera is sometimes a good choice. After women “get over the hump” of the first few months of irregular bleeding, most women will have either light, regular periods or no periods at all: In clinical studies, 55% of women reported no periods after one year of use. This makes Depo-provera a reasonable choice for some women with heavy periods. Some women who cannot safely use the Pill (for example, women who are breastfeeding, or women over 35 who smoke) can use Depo-Provera. In certain women, Depo-Provera may offer the best available contraceptive option. If you think Depo-Provera might be right for you, you should make an appointment to review your options with us.

Condoms

CondomsCondoms have been used for centuries to prevent pregnancy. Currently, there are dozens of varieties available including latex, polyurethane, lambskin, with or without lubrication, special textures, and other features. With perfect use (i.e., use with every sexual encounter, through the entire sexual encounter) pregnancy rates as low as 2% per year are achievable. With “typical” use, however, some 15% of couples using condoms will conceive a pregnancy with each year of use. Some varieties of condoms are coated with nonoxynol-9, a powerful spermicide which provides an added level of protection against pregnancy. Recent studies, however, suggest that nonoxynol-9 facilitates the acquisition of the HIV virus; several manufacturers have withdrawn their nonoxynol-9 coated condoms from the market.

Condoms are the only form of contraception which provides protection against most sexually transmitted diseases, including HIV. This makes condoms a good choice for women in non-monogamous relationships. Note that condoms provide better protection against agents which are transmitted via bodily fluids (e.g., HIV) than against agents which are transmitted by skin-to-skin contact (e.g., HPV or human papillomavirus).

Condoms are the only form of contraception which provides protection against most sexually transmitted diseases, including HIV.

If you plan to rely on condoms for contraception, you should plan to use condoms for every act of intercourse, from beginning until end: Condoms need to placed fully on the penis before any contact, and left on throughout the act of intercourse. They also must be held onto the penis when your partner pulls out of you. To be really protected against sexually transmitted diseases (STDs), condoms should be worn during vaginal, anal, and even oral penetration. All of this, of course, requires a willing partner.

Since latex allergies are fairly common, women (or men) may sometimes find condoms to be irritating. Non-latex condoms made of polyurethane or lambskin can be used if typical latex condoms are found to be irritating. Note that lambskin condoms have been shown to offer less protection against STDs than other types of condoms.

It is acceptable to use lubrication with condoms, but only water- or silicone-based lubricants should be used; oil-based lubricants can break down latex, and impair protection against pregnancy and STDs. Lubricants which are safe to use with condoms include K-Y Jelly and Astroglide. Lubricants like Vaseline (petroleum jelly) or baby oil shouldn’t be used.

Diaphragms

A diaphragm is a dome-shaped piece of latex or silicone that is inserted into the vagina prior to intercourse. Used with spermicide, it forms a protective seal around the cervix, and prevents entry of sperm into the uterus. Diaphragms are supposed to be placed with spermicide in the vagina before intercourse, and remain there for at least 6 hours after intercourse. With perfect use, failure rates of around 6% are expected. With typical use, however, failure rates are usually 15-20%. This means that 15 or 20 out of every 100 women relying on a diaphragm for contraception will get pregnant each year.

Like condoms, diaphragms can cause irritation. Sometimes this is due to sensitivity to latex in the diaphragm, but improper fitting can also be a cause of irritation. (Diaphragms are available by prescription only; to obtain one, women need to be “fitted” with a proper size, usually by a gynecologist.) Diaphragm use is also associated with an increased risk of UTI. Unlike condoms, diaphragms do not protect against STDs.

Because of their relatively high failure rate—and also because they are a bit of a nuisance to use—diaphragms are no longer the popular choice they once were: Prior to introduction of the Pill in 1960, diaphragms were used by one third of married couples in the U.S. In the last five decades, diaphragms have largely fallen out of favor, chiefly as a result of superior methods becoming avaialable. Now, less than 1 in 500 married couples relies on a diaphragm for contraception.

IUD (Intrauterine Device)

The intrauterine device is a small T-shaped device that is inserted through the cervix into the uterus by a medical professional. Once the IUD is in place, it provides effective contraception for 3, 5 or 10 years, depending on which type of IUD is used. At the end of 5 or 10 years—or anytime earlier if a woman wishes—the IUD can be removed, also by a medical professional. Fertility is expected to return immediately after the IUD is removed. Visit our IUD (Intrauterine Device) page to learn more.

Permanent Birth Control

For women who are certain that they have completed their families, sterilization may be an attractive option. Tubal sterilization is a procedure in which the fallopian tubes are permanently sealed off in order to prevent pregnancy. Once the fallopian tubes are sealed, the sperm and egg cannot meet, and pregnancy does not occur. Tubal sterilization was first reported in 1880, and now used worldwide by more couples than any other method of contraception. Visit our Permanent Birth Control page to learn more.

Natural Family Planning (the “Rhythm Method”)

Women can only become pregnant around the time of ovulation. One simple method for preventing pregnancy is to simply avoid intercourse around the time of ovulation.

In an idealized 28-day cycle, in which your period start on day 1 and the next period begins on day 29, women are expected to ovulate around day 14. If your cycle is longer, your expected date of ovulation will be later (e.g, in a 35-day cycle, ovulation is expected around day 21). Allowing for some variation in cycle length from month to month, some variation in the exact day of ovulation, and the fact that sperm and egg can live in the genital tract for a day or two, you can make a calendar like this:

Fertile Calendar

So, for women with a 26- to 32-day menstrual cycle, days 8 through 19 represent “fertile” days. Pregnancy is considered unlikely if intercourse occurs on other days. Thus women can avoid pregnancy by avoiding intercourse on fertile days (or using other forms of protection like condoms on those days).

This is a simplified example of calendar-based natural family planning. Much more complex calendar-based systems have been devised. There are also “symptoms-based” natural family planning methods which rely on symptoms of ovulation: Because ovulation is associated with changes in cervical mucus and slight changes in body temperature, women can be taught to identify signs of ovulation, and to avoid pregnancy when symptoms suggest ovulation is occurring.

Natural family planning costs nothing and has no side effects. For women who are practicing Catholics, it is the only form of contraception sanctioned by the Church. Unfortunately, however, natural family planning methods have a relatively high rate of failure. They also require a significant commitment by women to track their cycle and/or symptoms on a daily basis.

Women who choose natural family planning should have a high tolerance for failure: If pregnancy would be a colossal life disaster, this method is probably not right for you. Still, we would be happy to provide you with resources to improve your chances of success.

Emergency Contraception

Emergency contraception can help prevent pregnancy after unprotected intercourse. Several forms of emergency contraception are available, including:

  • The “morning-after pill”: Emergency contraceptive pills available without prescription to adult women. Popular brands include Plan B One-Step® and Next Choice®. Plan B One-Step consists of a single pill, while Next Choice consists of a 2-pill regimen.
  • Prescription emergency contraception may consist of 2 double-doses of certain types of birth control pills (under a physician’s supervision), or a prescription medication called ella®.
  • Emergency IUD insertion: Insertion of an IUD a few days after unprotected intercourse can prevent pregnancy.

Over-the-counter emergency contraception is most effective if it is used within 72 hours of unprotected intercourse—the sooner the better: Emergency contraception is about 95% effective in preventing pregnancy if it is used within 24 hours of unprotected intercourse, but the efficacy falls below 90% within a few days. Evidence suggests that over-the-counter emergency contraceptives remain fairly effective up to 5 days after unprotected intercourse, even though package labeling indicates that they must be used within 3 days. The prescription medication ella is more effective at preventing pregnancy, especially if not used immediately. Emergency insertion of an IUD is extremely effective at preventing pregnancy, but it is often difficult to make arrangements to have an IUD inserted within days of unprotected intercourse.

Emergency contraception is not the same as the “abortion pill”: While medications do exist which will abort an early pregnancy, the “morning-after pill” works by preventing conception.

Emergency contraception can be useful if you have had unprotected intercourse; if you “messed up” with your pills, your patch, or your ring; or if your partner’s condom broke or came off. It is also useful for women who have been forced to have intercourse against their will.

Some side effects are common with emergency contraception. If high doses of birth control pills are used, nausea and vomiting, breast tenderness, headaches, and dizziness may occur. Women who use over-the-counter emergency contraception often have disorganized bleeding for the remainder of their cycle.

Emergency contraception is not a substitution for reliable contraception: Other more reliable forms of contraception with fewer side effects are available. Women who find themselves frequently in need of emergency contraception, however, are often best served by acquiring it in advance, so they have it in their medicine cabinet when needed.


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