Other Reversible Contraception

1.  ImplanoniStock 000004732762XSmall

2.  Nuvaring ("The Ring")

3.  Ortho-Evra ("The Patch")

4.  Progestin Only Pill ("The Mini-Pill")

5.  Intra-Uterine Devices (IUDs)

6.  Depo-Provera ("The Shot")

Do you need reversible contraception, but have a really hard time remembering to take the pill? Any of these methods, along with barriers to prevent STDs, might be a good option for you.

Do you have a condition that makes it difficult or dangerous for you to have estrogen (personal or family history of blood clots, over age 35 and smoking, obese or high blood pressure, ocular migraines, seizures, diabetes, lupus, among others...)? Then any of the last four options might be good reversible choices for you, along with barrier contraception to prevent STDs.

Implanon

Implanon is a simple and easy contraceptive method that is very effective (more than 99%) and requires little thought or "remembering" unlike the pill. It is very popular among women ages 16 to 30. Implanon is a small, thin, implantable hormonal contraceptive that is effective for three years, and is easily removed (unlike its predecessor, Norplant). It is more than 99% effective at preventing pregnancy. It is very discreet - most women can't see it after it's been placed. Only you and your healthcare provider will know you're using it. For this reason, you should tell all of your healthcare providers if you are using Implanon.

Implanon prevents pregnancy in several ways. The most important way is by stopping release of an egg from your ovary. Implanon also changes the mucus in your cervix and this change may keep sperm from reaching the egg. Also, Implanon changes the lining of your uterus.

Once Implanon is successfully removed, your ability to get pregnant usually returns quickly. Some women have become pregnant within days after removal of Implanon.

After removal, if you do not want to become pregnant, you should start another birth control method right away.

Your healthcare provider will insert (or remove) IMPLANON® in a minor surgical procedure in his or her office. Implanon is inserted just under the skin on the inner side of your upper arm.

The timing of insertion is important. Depending on your history, your healthcare provider may ask you to:

  • Have a pregnancy test before insertion
  • Schedule the insertion at a specific time of your cycle (for example, within the first days of your regular menstrual bleeding)
  • Use a backup method of birth control, such as condoms, for seven days after IMPLANON® insertion

Both you and your healthcare provider should check that Implanon is in your arm by feeling the Implanon implant.

If you and your healthcare provider cannot feel Implanon use a non-hormonal birth control method such as condoms until your healthcare provider confirms that Implanon is in place.

You will be asked to review and sign a consent form prior to inserting Implanon. You will also get a USER CARD to keep at home with your health records. Your healthcare provider will fill out the insertion and removal dates. Keep track of the removal date and schedule an appointment for removal with your healthcare provider on or before the removal date.

The insertion site is covered with two bandages. Leave the top bandage on for 24 hours. Keep the smaller bandage dry, clean, and in place for three to five days.

Be sure to have checkups as advised by your healthcare provider.

Nuvaring ("The Ring")

The Nuvaring is a soft pliable ring placed in the vagina for 3 weeks. It slowly releases both an estrogen and a progestin. Usually it is removed after 3 weeks, and you have a period, then place another. However, like the pill, it can be used on a continuous basis. Place it in the vagina for 3 weeks, remove it and place another, for 9 to 12 weeks at a time. Like the oral contraceptive pill, it does not protect against HIV and other STDs, simultaneous barrier methods (hyperlink) are recommended for protection against these.

If you are considering the Nuvaring, please read through the information on the oral contraceptive pill (hyperlink). Almost all of the same risks, benefits, and side effects apply. In some studies, there is less break-through bleeding with Nuvaring.

Ortho-Evra ("The Patch")

The patch is applied weekly then removed and replaced with another for 3 weeks, then you keep it off for one week while you have your period. The estrogen dose that your body sees is a little higher than with the pill, so breast tenderness is more common, and some of the serious side effects are slightly more common, including risk of blood clots. Otherwise, the same principles apply, as for oral contraceptive pills. Please read through that section if you are considering the Patch. Like the oral contraceptive pill, it does not protect against HIV and other STDs, simultaneous barrier methods are recommended for protection against these.

Progestin Only Pill ("the mini-pill")

The Progestin only pill works mostly by thickening the cervical mucus. It does not consistently suppress ovulation, so it must be taken every day, at the same time every day. It lasts about 22 hours (not 24), so timing is important. It starts to work by thickening the mucus about 2-4 hours after it's taken. It is about 97% effective with typical use, and 99.5% with ideal use. It is a great option for women in whom estrogen is undesired or contra-indicated. It does seem to slightly increase insulin resistance. Like the regular pill, it does not protect against HIV and other STDs.

The Intra-Uterine Device

1.  What is an IUD?

2.  How does an IUD work?

3.  How are they Inserted?

4.  How effective are they?

5.  How long can I keep an IUD in?

6.  What are the risks?

7.  Where can I find out more information?

What is an IUD?

An IUD is a medical device that is placed by a clinician through the cervix and into the uterus itself, where it is intended to stay for a period of up to 5 to 10 years, depending on the device, or until pregnancy is desired.

How does an IUD work?

It is generally believed that the IUD works by creating a hostile environment for a fertilized egg to implant into. However other studies suggest that it works instead by creating a hostile environment for the sperm to survive in long before an egg is ever fertilized. The truth is no one really knows. However it is an important question for those who feel strongly that life begins at conception, since they may have ethical issues with creating a hostile environment for an already fertilized egg.

How is an IUD inserted?

In our office, we usually start with a consultation, during which we discuss all your contraceptive options. If you choose an IUD, we try to time the insertion such that we are putting it in during your period. This sounds a little messy (it really isn't) but has advantages. Your cervix is slightly open at that time, and we know you aren't pregnant. We usually have you take antibiotics for 12 hours before the procedure and a little Ibuprofen to reduce cramps about 1 hour before. We usually place a paracervical block. This is local anesthetic that makes your uterus and cervix numb. Then we place the device thought the cervix into the uterus and release it with equipment that comes with the device, using a sterile technique. We observe you for 15 minutes, since sometimes people are a little lightheaded for a few minutes after we manipulate the cervix. Then you go about your day.

How effective are they?

The IUD is about 97% effective i n preventing pregnancy. It does not prevent STDs such as HIV. It does not require much thought, and provides long term reversible contraception. It comes in a form that is non-hormonal (Paraguard) and one that contains progestin (Mirena). The progestin containing IUD can decrease menses over time to the point that 30% of women don't have them anymore.

How long can I keep an IUD in?

5 years for Mirena (levonorgestrel) and 10 years for Paragard (copper)

What are the risks?

Risks of the procedure are small, but include bleeding, and a small risk of infection, for a few months after placing the IUD. After that the risk of infection if you are not exposed to an STD, is no higher than usual.

Risks of having an IUD:

1.  If you are exposed to an STD, such as chlamydia or gonorrhea, you have given the bacteria a rope to climb right up into your uterus, tubes and pelvis. So an infection that might have otherwise stayed local to the cervix can "ascend" and spread more easily. For this reason, IUDs are not recommended for those at increased risk of STDs.

2.  Expulsion: The uterus contracts and expels about 10% of IUDs in the first year, and a small proportion in subsequent years. Usually you have cramping, vaginal discharge and/or uterine bleeding when this happens, but sometimes there are no symptoms.

3.  Heavier menstrual bleeding, painful menses, pain with intercourse: About 15% of women have their IUDs removed for these reasons prior to desiring pregnancy again, or the IUD needing replacing.

4.  Ectopic pregnancy - While the risk of pregnancy of all kinds (including ectopic) is decreased, if you do have a pregnancy with an IUD, it is more likely to be ectopic.

5.  Very occasionally, an IUD may become embedded within the walls of the uterus or displaced or the strings retract. In this case, IUD removal may require a simple in-office procedure called hysteroscopy.

Where can I find out more information?

For more information about Paraguard, click here.

For more information about Mirena, click here.

Depo-Provera ("the Shot")

Depo-Provera has the advantage of being a long acting injectable form of contraception that you only have to remember every 3 months. That's a huge advantage. It has a very low failure rate. It does not protect from STDs and HIV.

However Depo-Provera, over time, has significant side effects, which include a significant amount of weight gain, mood changes, irritability and depression for some women, irregular uterine bleeding that can persist several months, adversely affecting cholesterol levels, bone loss, and a delay in return to fertility of up to a year after discontinuing.

So risks must be carefully weight against benefits in making a decision.

Debra Ravasia, updated 2017