WEIGHING THE PROS & CONS

Can you briefly discuss the risks and benefits of some of the most commonly available contraceptive choices, including IUDs and implants vs. contraceptive pills, patches and vaginal rings?

Among the long-acting options are the copper intrauterine device or hormonal IUD, contraceptive implant and injections (also known as long-acting reversible contraception methods, or LARC). In addition to being highly effective, they don’t require repeated action from the user. Long-term contraceptives with progesterone also have the added health benefit of reducing menstrual cramps and menstrual blood loss translating to increased hemoglobin and iron stores. IUDs are also associated with decreased risk of endometrial cancer. Placing and removing the long-acting birth control methods typically requires the patient to undergo a minor procedure during an office visit, which most women tolerate well. Side effects, such as menstrual disturbances and pain, are usually not disturbing to most patients as long as they are well informed about the method.


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However, the short-term contraceptive methods have advantages as well. The hormones (estrogen and progesterone) in the pills, rings and patches can help regulate a woman’s menstrual cycle, decrease menstrual bleeding and cramping, and even be protective against ovarian cancer by suppressing ovulation. When women use the shorter-term methods, they must remember to either take a pill every day or to replace the ring or patch at regular intervals. A memory lapse can lead to contraceptive failure.

How should physicians discuss these different methods of contraception with their patients and how do they ensure the right match for each woman?

In addition to understanding a woman’s goals regarding pregnancy prevention, discuss and compare methods, and narrow down the choices. The best birth control method for an individual or couple is one that is safe and that will be used properly and consistently. In addition to personal considerations, key factors influencing a patient’s choice of contraception include effectiveness, safety, cost, risks, benefits and side effects. Physicians should understand whether a woman is willing to accept a method that requires repeated action (pill, patch, ring, barrier methods), undergo the small procedures used to place long-term birth control, or tolerate side effects such as changes in the menstrual bleeding patterns (IUDs, implant, injection), or if she has a need for protection against sexually transmitted infections (condoms with or without other methods of birth control).

A physician might want to begin the conversation by first discussing the most effective methods of contraception, followed by other options. The provider should give the patient enough information about different methods to weigh the pros and cons.Because there is so much information to digest, it may be advisable to give patients information before their appointments, so they have a basic understanding of the various options before discussing them with their practitioners. One good resource for patients in this area is www.bedsider.org, which outlines the available options and information about advantages and drawbacks. One positive feature of this site is that it includes real stories from patients talking about their experiences with the various methods.

RESOURCES

1. Winner B, Peipert JF, et al. Effectiveness of Long-Acting Reversible Contraception. N Engl J Med 2012; 366:1998-2007.

2. Centers for Disease Control and Prevention. Prevention guidelines, U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf. Accessed on June 14, 2012.