If you’re having the type of sex that could get you pregnant and you don’t want to have a baby any time soon, you’ll have probably been offered “the pill”, (officially: the oral contraceptive pill). The method was once a better-known and more popular birth control option than a long-acting reversible contraceptive (LARC). They can both be great options—but the best form of contraception for you really depends on what you want out of your birth control and how you respond to a new method once you make the commitment.
“Most patients know what their birth control focus is, whether that’s the level of effectiveness against getting pregnant, convenience, portability, or concern about side effects,” Samantha M. Dunham, MD, clinical associate professor in the department of obstetrics and gynecology at NYU Langone Health, explains.
A combination of those factors might be important for you, and you’ll want to find a birth control method that ticks all your boxes. So, if you’re currently taking the pill and looking to explore long-lasting options that don’t require daily thought, here’s what you should consider.
First, let’s discuss the difference between birth control pills and LARCs.
The pill, also known as the combination pill, contains the hormones oestrogen and progestin. It’s most effective when taken orally each day. There are many different brands and types of the pill, but all include some combination of these two hormones.
On the other hand, LARCs can offer several weeks’ to several years’ worth of protection and can be reversed if and when you decide you’re ready to start trying for a baby. These include the copper IUD (which lasts up to 12 years), the hormonal IUD (which lasts about 3 to 8 years, depending on the brand), and the hormonal implant (good for up to three years)—all highly effective and easy-to-use forms of birth control.
You could also consider using a contraceptive patch (which you need to change weekly), a vaginal ring (which you need to change every three to five weeks, depending on the brand), or contraceptive injections (which you need to receive every three months). These are all great options, too, if you want to avoid taking a daily pill but don’t last as long as an IUD or implant.
LARCs include either an IUD or an implant, so we’ll be focusing on those methods below.
When should consider making the switch from the pill to a LARC instead?
If you’ve been on the pill for a while and don’t think it’s working out for you, or you’re simply weighing up your options, here’s how to know if it might be time to switch to a long-acting reversible birth control method.
If you forget to take your pill now and again, you’re not the only one. According to CDC data published in 2017, 15% of women between the ages of 15 and 44 missed one oral contraceptive pill, and 16% missed two or more pills within a four-week period.
If you miss one pill but have been consistent previously, you probably don’t need a backup plan or emergency contraception. You can simply take two pills in one day to stay on schedule. If you miss two pills, you should take the most recent missed pill as soon as you remember and then continue taking it as normal, but you should also use backup birth control (like a condom), or—if pregnancy is your biggest concern—avoid penis-in-vagina sex altogether until you’ve taken the pill for seven consecutive days.
If you can’t ever remember to actually take the pill when you’re supposed to, or are often late refilling your prescription each month, a LARC takes away that responsibility. “A LARC’s main advantage is ‘set it and forget it,’” Dr. Dunham says. “It may require more effort to start up, but requires less effort over time.” Basically, once it’s in, you’re good to go. No daily alarms or relying on good memory required.
Research estimates that LARCs are up to 20 times more effective against pregnancy than the pill. Each LARC method is over 99% effective in preventing pregnancy. In theory, the same goes for the pill — but only if it’s used perfectly (more on that later). A more realistic figure for the effectiveness of the pill in preventing pregnancy, based on typical use, is 91%, according to Planned Parenthood. In other words, about 9 out of 100 pill takers get pregnant each year.
On the flip side, the pill can be appealing if you eventually decide you want to get pregnant, Dr. Dunham says. “It’s easy to stop and doesn’t require a doctor’s visit to start trying to conceive,” she explains.
Even if you want to get pregnant in the near future, you can still use a LARC method for birth control in the meantime. “LARC doesn’t affect or decrease your chance of getting pregnant in the future,” explains Anita Sit, MD, chief of gynaecology at Santa Clara Valley Medical Centre. The hormonal implant and IUDs require removal at your doctor’s office, but the process is generally quick and easy for most people.
When you stop taking birth control, it can take a bit of time for your cycle to return to normal. A 2020 study that analysed data from nearly 18,000 people who menstruate found that fertility returned quickest in those who had used IUDs or implants; they waited for an average of two menstrual cycles before conceiving, while pill users had to wait for three cycles.
Sometimes, your health history or lifestyle choices factor into your choice of birth control. If you’re older than 35 years and smoke, for example, your doctor may advise you not to take the pill due to the changes increased oestrogen levels can make to your blood. The same goes if you have a history of blood clots, breast cancer, or in some instances, high blood pressure, among other health conditions.
However, these things don’t rule out another type of birth control pill: the progestin-only pill, also called the mini pill. It can be a good option for people who can’t take oestrogen, but it has to be taken at the exact same time each day (there’s even less room for error) so you need to be even more diligent.
Alternatively, a LARC can be used if you have a condition that prevents you from taking the combination pill, Dr. Sit says. For instance, the IUD and implant, which also only contains progestin. Most people can use a LARC without serious concern, but each type has its own contraindications, so make sure to discuss that with your doctor. (For example, you shouldn’t use the copper IUD if you have a disorder that makes it hard for your blood to clot)
Every type of birth control comes with potential side effects, but there’s no guarantee how — or even if — you’ll be affected. The most common side effects of the pill are sore breasts, nausea, and headaches. Spotting or bleeding between periods is also possible. These side effects usually go away within a few months, after your body gets adjusted to the hormones. There are potentially serious side effects of the pill to be aware of, namely blood clots and worsening high blood pressure, Dr. Sit says, but these are rare.
Side effects aren’t always a bad thing, though. In fact, lots of people opt for the birth control pill in the hope that it will ease painful, heavy periods. Some types of birth control pills also help heal and prevent hormonal acne, adds Dr. Dunham.
LARCs have their own potential side effects too. The most common adverse effects reported with the copper IUD are heavy menstrual bleeding and pain. If you opt for the implant, you might notice changes in your menstrual bleeding patterns after insertion, like an absence of bleeding (amenorrhea) or infrequent, frequent, or prolonged bleeding. Other reported adverse effects of the implant include gastrointestinal issues, headaches, breast pain, and soreness and swelling in or around the vagina (vaginitis).
This article originally appeared on SELF.
What are the different contraceptive alternatives to consider?
As mentioned, there are few different contraceptive options to consider:
The copper coil, or IUD, has a dual role as a long-term contraception and as an Emergency Contraception, shares Edith Barber, a specialist nurse practitioner at the Harley Street Health Centre.
‘The effect of the copper coil makes the area of the womb hostile for a sperm and egg to survive in the womb or fallopian tubes therefore preventing fertilisation of an egg. They play a role to interfere with the structural appearance of the lining of the uterus thereby disturbing the process of implantation.’
There are three types of hormonal coils, which contain a Progestogen type hormone called Levonorgestrel, says Barber. “The maximum duration of use with the hormonal coil option is 5 years whereas the non hormonal coil has a 10 year duration option.”
Some have hormones and some don’t. “They also act in a different capacity with the IUS mode of action being that it thickens the cervical mucus which makes it more difficult for sperm to move through and fertilise and egg, it thins the lining of the womb of the whom which prevents implantation of an egg and it partially supresses ovulation in some women.”
A small flexible plastic rod that’s placed under the skin in your upper arm, the hormonal implant lasts for 3 years, according to the NHS.
“The contraceptive patch is a small soft sticky plaster that you place on your skin that contains two hormones that is used to prevent pregnancy,” says Barber. “It is replaced on a weekly basis for 3 weeks followed by a week off.”
“If the vaginal ring is always used perfectly according to instructions, it’s over 99% effective. This means that fewer than 1 in 100 people who use the ring perfectly will get pregnant in 1 year,” she says. However, if the vaginal ring is not always used according to instructions, it can increase your risk of getting pregnant. ‘About 9 in 100 ring users will get pregnant in 1 year,” she adds.
Google searches for contraceptive injections and their safety are high. But, according to Barber, any contraindication to its use will be flagged following consultation with a patient and they are generally considered to be safe.“It is a discreet, reliable contraception method that can be administered by both patients or clinicians,” she adds.
What is the most effective birth control besides the pill?
“Due to the low incidences of failure rate, the most effective group of birth controls are the LARC methods,” shares Barber.
Examples, as mentioned, include the Intrauterine Device (IUD), Intrauterine System ( IUS), Contraceptive Implant and Contraceptive Injection.
What are the benefits of longer-lasting contraception?
Below Barber maps out the possible benefis to consider:
- More reliability out of all the methods and lower incidences of failure rate in comparison to other methods
- Your fertility returns back to normal immediately; with the exception of the contraceptive injection which may take slightly longer.
- Low maintenance: no incidence of you running out of prescription
- Cost-effective
- Discreet to use: within the womb (coils) or beneath skin ( implant) injection (no trace)
- Empowers women to decide and take control how, when she wishes conception
- Can be used at any age
- Immediate effectiveness (copper coil)
- Previous pregnancy is not a contraindication to insertion
- Positive effect on your sex life and reduction with anxiety during or after sex
- They can provide desired hormonal side effects for as long as is needed. For example, Mirena may be needed to support a person who is using hormone replacement therapy (HRT), who suffers from heavy periods of endometriosis and desires no period. Alternately, for people who do not want any hormonal contraception or who cannot have certain hormones, a Copper coil, which can last 5 or 10 years, is available and contains no hormones.
Are there any side effects to consider with LARCs?
There can be various side effects specific to the method being used, says Barber. “Hormonal LARCs can cause bleeding related side effects (irregular/ prolonged/no period), headaches, breast tenderness or mood changes,” she says.
‘Non hormonal coil bleeding can be heavier longer or more painful periods, Depo can cause weight gain and also bleeding-related side effects.’
At the end of the day, the side effects of the pill and LARCs will vary a ton from person to person. It’s important to choose a form of contraception that has minimal side effects for you, which again is sometimes easier said than done. On the NHS website, you can find useful tools for working out the best contraceptive method for you as you can on the website Contraception Choices.
But if the pill makes you feel awful or doesn’t seem to agree with you, ask your doctor about other options. A LARC may be a better choice for you—and it comes with the undeniable bonus of being protected against pregnancy every single day without having to remember to take a medication.
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