Contraceptive Options In 2017

By Anne Brown, MD, FACOG

Capital Women's Care

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Contraceptive Options In 2017

While the “pill” is still alive and well in a wide variety of forms, there are also a number of other methods to prevent pregnancy and control menstrual flow available these days.

The IUD has been around for decades, but has enjoyed a surge in popularity due to its extreme efficacy (unintended pregnancy of less than 1%) and long-term duration of use. In addition to the Paragard Copper T, which lasts 10 years, we now have a variety of progesterone-based IUDs, including the Mirena and Kyleena, Liletta, and Skyla.

Of course, any of these methods can be removed at any time if pregnancy is desired. In a monogamous woman, the rate of infections is extremely low, and they are even approved for adolescent girls. Many insurance companies, particularly since the ACA was passed, cover these and other contraceptive costs. Side effects with the IUD are very few, and people who have had trouble with hormonal contraceptive side effects can still use progesterone-based IUDs without problems.

The other option that is available for long-term contraception is the Nexplanon implant, which is a single capsule placed under the skin of the inner arm in a simple office procedure. It lasts for up to three years and prevents ovulation like the pill does, but with just progesterone. Some patients do experience irregular, usually light bleeding, on this method. Some others may not bleed at all, similar to the way patients who use the “shot” (Depo-Provera) or extended-cycle oral contraceptives don't.

Finally there is the Nuvaring monthly vaginal insert that works similar to the pill but only has to be dealt with once a month. Ortho Evra is the weekly skin patch that is also less cumbersome than a daily pill and both are somewhat less likely to fail than the pill due to a decreased chance of forgetting to use it.

The Essure method of office-based sterilization has gotten some bad press of late, but is actually very unlikely to cause major complications and is much less risky compared to the traditional tubal ligation procedure done in the operating room. It is associated with little to no downtime from work. There is a need to perform a radiologic study three months after the procedure to insure the scar tissue formation as led to complete tubal obstruction.