Oral contraceptives are made of estrogen and progesterone. The Pill is taken daily to prevent ovulation. It is important that birth control pills be taken every day, preferably at the same time each day. The fourth week of the pack consists of inactive, placebo pills. It is during this week that a woman will experience bleeding similar to a normal menstrual period. When birth control pills are used correctly, they are more than 99% effective. This is the most popular method of contraception in our country. Birth control pills do not protect against sexually transmitted infections. Common side effects are nausea, headache, and irregular spotting. These side effects, if they occur, often resolve after the first few months of use.
Combination estrogen and progesterone birth control pills are not recommended for a nursing mom. However, there is a progesterone-only birth control pill which is safe for nursing. It is also known as the minipill. The minipill also prevents ovulation. The minipill is about 95% effective. Since combination birth control pills are more effective than the minipill, once a nursing mom has decided to wean, we prefer that she switch to combination birth control pills.
The ParaGard® IUD is becoming increasingly popular. It is a small, soft, plastic device which also contains copper. It is placed into the uterus by a physician as an office procedure. It begins working as soon as it is inserted, and it may be used for up to ten years. However, it can be removed at any time. It is 99% effective. It works by reducing the sperm's ability to swim and by preventing fertilization. There are no hormonal side effects.
The Mirena IUD contains progesterone. Each device lasts 5 years. Irregular spotting is common in the first year, but after that many women do not have periods at all.
There were some IUDs on the market in the past which were associated with complications. The new IUDs do not increase your risk of pelvic inflammatory disease. They are designed for women who have had at least one baby and are in a mutually faithful, monogamous relationship.
The advantage of the IUD is that you don't have to think about it every day the way you do with the birth control pill or with barrier methods. Patient satisfaction with IUDs is among the highest of any reversible method. This is because it does not require daily attention and has a high degree of effectiveness as well as convenience.
Depo-Provera® is given as a shot in your upper arm or hip. It consists of progesterone which is released into your system over a period of three months. It prevents ovulation. It provides highly effective contraception for three months. It is a popular method of contraception among nursing moms since it is safe for breast feeding and does not decrease the milk supply. The most common side effects are irregular spotting, a small weight gain, or a delay in return of fertility beyond the three months of use.
Nexplanon® is a single-rod subdermal contraceptive implant that is inserted just under the skin of a woman's upper arm and contains etonorgestrel. Nexplanon® is a type of long-acting reversible contraception, the most effective form of birth control. A steady low dose of progesterone is delivered into the system. This prevents ovulation. It is effective for up to 3 years. It can be removed earlier if the patient does not like it. Insertion and removal is a simple office procedure under local anesthetic. The Nexplanon® is more than 99% effective. Common side effects include menstrual irregularities and mood changes. Visit their website for more information.
A diaphragm is a soft rubber, latex, or silicone cup that is filled with contraceptive jelly or cream and inserted into the vagina to cover the cervix. It provides a physical barrier to semen and holds the contraceptive jelly which kills the sperm before they can enter the uterus and fertilize an egg. The diaphragm should remain in place for six hours after intercourse, and should be removed as soon as possible thereafter. Diaphragms should be replaced every two years. Use of the diaphragm may increase a woman's risk of urinary tract infections. The diaphragm is about 80% effective.
The male condom is worn on the penis. It collects semen and prevents sperm from entering the uterus. It is 88% effective. The female condom is a lubricated plastic sheath with the rings on each end. The ring on one end is open and remains outside the vagina, covering part of the labia. The ring on the other end is closed with the plastic and looks like a diaphragm. It is placed in the vagina so that it covers the cervix, preventing sperm from entering the uterus. The sheath between the two rings forms a pouch to line the entire vaginal area.
The use of the male condom and the female condom can help prevent the transmission of sexually transmitted diseases. Both are available without a prescription. The female condom can be inserted up to eight hours before intercourse.
Essure® is a permanent, non-surgical transcervical sterilization procedure for women. It was approved by the FDA in 2002. Small, flexible inserts are placed into the fallopian tubes by a catheter passed from thevagina through the cervix and uterus.
The insert contains inner polyethylene terephthalate fibers to induce benign fibrotic reaction and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil.
Once in place, the device is designed to elicit tissue growth in and around the insert to form over a period of three months an occlusion or blockage in the fallopian tubes; the tissue barrier formed prevents sperm from reaching an egg.
Unlike other forms of tubal ligation, no general anaesthetic nor incision through the abdomen is required.
Similar to some other methods of birth control, initially additional forms of birth controlmust be continued for 3 months to prevent pregnancy until the method's effectiveness can be confirmed.
For the Essure® method, three months after insertion a physician performs an x-ray test called a hysterosalpingogram to confirm that the fallopian tubes are completely blocked and that the patient can rely on the Essure® inserts for birth control. A contrast agent (dye) is injected through the cervix, and an x-ray technologist takes photos of the Essure® coils to ensure that they are in place.
For more information, view this segment on The Doctors.
Tubal ligation is performed with an instrument called a laparoscope as an outpatient surgery. The surgery takes about a half an hour. Recovery is within a few days. There is about a 1 in 300 failure rate. It is considered permanent. You should not consider tubal ligation unless you are sure that you do not want to have anymore children. It is very difficult to have the tubes put back together. Tubal reversal is not always effective. It is often not covered by insurance. Vasectomy is done by a urologist as an office procedure. Female sterilization is immediately effective. Vasectomy is only effective after multiple ejaculations when the existing sperm are cleared out of the vas deferens.
We recommend Depo-Provera®, the IUD, and Micronor (the "minipill") for post partum contraception. Breast feeding is not a reliable birth control option. Although nursing can in some cases delay or even prevent the return of your period, it does not necessarily prevent you from becoming pregnant.
Whether or not this is your first baby, it is not too soon to consider when or if you would like your next, and what you are going to do about family planning. Going through another pregnancy may be the last thing on your mind at this time, but it is best to think it over now so that you are prepared for the future.
Other options for postpartum birth control include combined oral contraceptives for women who are not breast feeding, the diaphragm, condoms, and sterilization.