What You Need to Know about Birth Control

By Eliana Osborn

Although it’s not often thought of this way, birth control has been one of the most important elements in women’s freedom. The right to choose how many children one would have, or none at all, allowed women to manage their lives in an unprecedented way. The first birth control pill went on the market in 1960. Since then, a lot has happened in the world of pregnancy prevention, allowing more precision and fewer side effects. For women who want to avoid hormones entirely there are great options that you don’t have to think about every day.

So if you haven’t updated your understanding of birth control since what you learned when you first started thinking about it, now’s your chance. After 40 is when doctors see a spike in unplanned pregnancies—you’re still fertile even if babies aren’t on your mind.

Barriers (Condoms)

If you’re going to have a sexual encounter and are concerned about sexually transmitted diseases, you can’t rely on hormonal birth control to keep you healthy. The methods covered in the rest of this article keep sperm away from an egg. That doesn’t mean you are protected from infectious disease. You’ll need to use a condom. Even a diaphragm or cervical cap, in conjunction with spermicide, is better as birth control than disease prevention.

Long Term Options

If you have given birth but know you don’t want to go through that again for at least a few years, consider an IUD. The name gives you a lot of information here: intra-uterine device. This is a tiny, t-shaped piece of plastic or copper that is placed inside your uterus. The plastic version contains hormones, the copper one does not.

An IUD is a great option for women over 35 for a couple of reasons: no estrogen involved, you can get pregnant immediately after removing, can clear up period problems, 99% effective, and you don’t have to think about it for years.

The copper IUD can stay in place for up to 12 years while you figure out your long term plans; hormonal versions are about 5 years. The cost can be high if you are paying out of pocket, $500-$800, though most insurance plans cover them, since an IUD is lots cheaper than years of birth control pills or a baby.

Another choice if you don’t want to think about fertility for a while is a hormone implant. Nexplanon is the brand name and it goes under the skin in your upper arm. Since it lasts four years, again this is a bit pricey. Planned Parenthood estimates the cost at $850. Like a lot of hormonal birth control options, Nexplanon stops ovulation so most users enjoy lighter or nonexistent periods after the first year. Because there’s nothing to remember, the implant is 99% effective.

Mid-range Options

The Depo-Provera shot lasts three months and can be given by a doctor or nurse. It is hormonal, stopping ovulation, and is 94% effective. The side effects here are similar to birth control pills; some women gain weight or have breast tenderness, or you can have between period spotting. But four times a year is easier to remember than every day. But for women who know they want to get pregnant, it may take up to a year to get your cycles back to normal after stopping Depo Provera, so you’ll want to take that into consideration.

Another alternative is the birth control patch. These look a bit like a nicotine patch you might have seen and work the same way. You wear it on thin skin where the hormones can easily be absorbed: stomach, bottom, upper arm, or back. You put a new patch on each week for three weeks, then take a week off to have your period.

The patch works the same as a combination birth control pill, with both estrogen and progestin hormones. It doesn’t prevent your body from ovulating but prevents fertilization. You have to be sure to change your patch on the same day every week, which is why the real world effectiveness rate of this product is just 91%. Still, once a week is easier to keep up with than every day for some people.

Daily Birth Control

A daily pill is still the most common form of birth control. Combination pills with both estrogen and progestin were the first developed, but for women over 35 they are not a good idea. For these users, mini pills with just progestin are the safest bet.

Emergency contraception or the morning after pill, is another way to prevent pregnancy. Unlike other forms of birth control, this comes after sex instead of before. The most common kind has several brand names and can be purchased without a prescription in most drugstores. You may have heard of Plan B, but the others on the shelf all have the same drug in them. These all work better the sooner you take them, up to five days after sex.

The bottom line: While birth control pills are generally very safe and can help with lots of health problems besides preventing pregnancy, they aren’t right for everyone. This is one situation where total honesty with your health care professional is very important. That means being clear about smoking, heart health, family history of things like blood clots, and even migraines.