Birth Control Overview (cont.)
What is the effectiveness, and what are the side effects of other hormonal methods of birth control?
Implant: The FDA has approved a contraceptive implant (etonorgestrel, brand name Nexplanon). It is placed in the upper arm of the woman and releases a small, steady dose of progestin. It is extremely effective for up to three years.
- Effectiveness: Implants are as effective as surgical sterilization. Overall, pregnancy rates increase from 0.2% in the first year to 0.5% by the third year.
- Pros: Implants are durable. A woman's fertility returns shortly after implant removal.
- Cons: A minor surgical procedure is necessary to put them in and to remove them. Menstrual irregularities are common, along with other side effects, including weight gain, headaches, mood changes, growth of facial hair, and acne.
- Additional side effects and risks: Implants are often used for women who have just had a child and are breastfeeding; for those who have trouble remembering to take birth control pills or use other birth control methods, and for women who should not become pregnant because of a medical condition. Implants are not recommended for heavy smokers, women with a history of ectopic pregnancy, diabetes, high cholesterol, severe acne, high blood pressure, heart disease, migraine, and depression.
- STDs and the implant: This method does not protect against STDs.
Birth control patch: In the United States a transdermal patch (worn it on the skin) is available that releases estrogen and progesterone directly into the skin (brand name: Ortho Evra). Each patch contains a 1-week supply of hormones. It releases a constant daily dose of hormones equivalent to the lowest-dose oral contraceptive pill formulation.
- Effectiveness: In August, 2002, the FDA listed a failure rate for the patch of 1 pregnancy per 100 women per year, similar to that of other combination methods. It may be less effective for women who weigh more than 198 pounds.
- Pros: Many women find it convenient to use because it works for a week, and they do not have to remember to take a pill every day. You apply a new patch every week for 3 weeks and do not wear a patch during the fourth week when menses are expected.
- Cons: It is only available by prescription.
- Side effects of the patch: Side effects are similar to those experienced by women using oral contraceptives. The patch may cause skin irritation where it is placed (near the bikini line or on the buttocks or thighs). It may come off and not be noticed, for example, in the shower.
- STDs and the patch: The patch does not protect against STDs.
Vaginal ring: The vaginal ring (NuvaRing) is a newer form of birth control. The actual design of vaginal rings for contraception was first developed in the 1970s. Vaginal rings deliver a combination of estrogen and progesterone. The hormones are released slowly and are absorbed directly through the walls of the vagina.
- Effectiveness: Preliminary studies have shown that they work to prevent pregnancy, similar to birth control pills, with fewer side effects.
- Pros: Vaginal rings are used in the same manner as birth control pills, with the ring being left in the vagina for three consecutive weeks, followed by removal for a week during which time a menstrual flow is anticipated.
- Cons: If the ring is expelled spontaneously and remains out for more than 3 hours, another form of birth control should be used until the next period begins, at which time a new ring may be reinserted. The vaginal ring is only available by prescription.
- STDs and the vaginal ring: It does not prevent STDs.
Injections: An injection of a synthetic hormone depomedroxyprogesterone acetate (DMPA, brand name: Depo-Provera) can be given every 3 months to stop ovulation. You receive it by injection in the doctor's office. After injection, the medication is active within 24 hours and lasts for at least 3 months. It prevents your ovaries from releasing eggs.
- Effectiveness: DMPA is an extremely effective contraceptive option. Other medications or patient weight do not diminish its efficacy. The failure rate is approximately 0.3% during the first year of use.
- Pros: DMPA does not produce the serious adverse effects seen with estrogen, such as a tendency to increase blood formation. It lowers risk for certain types of endometrial cancers. Problematic irregular periods may normalize with Depo-Provera usage.
- Cons: Some women may cease menstruating within the first year of usage. Irregular bleeding can be treated by giving the next dose earlier or by adding a low-dose estrogen temporarily. Because DMPA lasts in the body for several months in women who have used it on a long-term basis, it can significantly delay a return to normal fertility. About 70% of former users desiring pregnancy conceive within 12 months, and 90% will conceive within 24 months. Other adverse effects, such as weight gain, depression, and menstrual irregularities may continue for as long as 1 year following the last injection. Recent studies suggest a possible link between DMPA and bone density loss. Results are conflicting and limited.
- STDs and Injections: This method does not protect against STDs.
Medically Reviewed by a Doctor on 11/20/2017
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