Choosing a birth control option that works well for you can seem overwhelming. So many different methods are available, each with their own advantages and disadvantages, which are important to consider before making a decision.

At Pandia Health, we provide women with all of their birth control options that they can get by mail (the birth control pill, patch, and ring), and we’re here to help you on your birth control journey. In this post, we will go over some of the topics that our doctors are most frequently asked about.

Pros and Cons of Hormonal Birth Control

Some women wonder whether they prefer a hormonal birth control method or one without hormones. Typically, we recommend hormonal birth control methods as they are more effective and can have health benefits beyond contraception such as improving acne and cramps. However, some women may not want hormonal methods for medical or ideological reasons so it’s important to understand non-hormonal birth control options as well.

Birth Control Options By Mail

Overall, hormonal birth control pills, the vaginal rings, and the patch are a great choice for women who want and need them. Combined hormonal birth control pills, patches, and rings are far more effective than abstinence or condoms, and both hormonal and non-hormonal methods are better at preventing unplanned pregnancies than the latter two options.

Per Contraceptive Technology, 13% of people using a condom as their method of choice will get pregnant versus 7% of those using the birth control pill, patch, or ring. As an added bonus, the pill can be used to treat acne, anemia, cramps, and polycystic ovarian syndrome (PCOS).

The ingredients on a package for birth control pills might seem intimidating given all of the scientific terms. In reality, the ingredients in hormonal pills are straight-forward and very similar to those already found in your body. Combined hormonal birth control contains two hormones: estrogen and progesterone. The amount of estrogen varies by the type of pill; although higher doses of estrogen increase the risk of blood clots, they also decrease the risk of breakthrough bleeding

While hormonal birth control containing estrogen and progesterone comes with a risk of blood clots, it is minimal, especially for those who are healthy. In fact, the risk of blood clots while on birth control is LESS than the risk of blood clots during pregnancy. To reduce the already small risk, if you’re a smoker/vaper, cut down on smoking.

If you go on long airplane flights (more than five hours), make sure you drink lots of water, take a baby aspirin or ibuprofen before the flight (to make your blood less likely to clot), and walk around during the flight. If you develop abdominal pain, chest pain, severe headaches, eye problems, or swelling in one leg, you might have a blood clot and you should seek medical help immediately.

You may have heard that hormonal birth control pills can cause weight gain. This is actually not true! Some women will get the munchies on the pill, but most do not. One literature review paper of 22 studies found limited evidence for weight gain while on the pill. It is possible that this is because women NOT on the pill have periods, which cause bloating that fluctuates over the course of a cycle, thus contributing to weight gain.

Furthermore, hormonal birth control can decrease your chance of endometrial and ovarian cancer. In fact, the pill is the only known method of reducing the risk of ovarian cancer besides surgically removing the ovaries. Note that for those who have breast or liver cancer, the pills can make the cancer worse.

While there is a link between birth control pills and breast cancer, the increased risk is only 13 per 100,000 woman-years of use versus the increased risk of getting breast cancer when one drinks 3-6 glasses of alcohol a week is 22 per 100,000 woman-years. Hence, the increased risk in breast cancer is less than the decrease in ovarian, endometrial, and colon cancer that comes from using birth control pills.

Other side effects that one may experience are nausea, irregular periods, and depression. Nausea can be an issue, for instance, if birth control is taken first thing in the morning on an empty stomach; taking it before bed or with your largest meal of the day will help.

If you spot while on birth control pills, it’s most likely because you didn’t take the pill at the same time every day or because you added a medication (this includes over the counter medications) that affects the metabolism of the pill by your liver. In terms of mental health, most women do not experience depression as a result of birth control, but switching to a different progestin can help if that is a side effect.

It’s important to know that hormonal birth control methods do not decrease fertility once you are off of them; when you are on birth control, as the name suggests, you are largely protected from unplanned pregnancy and, thus, infertile. The hormones in the birth control pills, patch, and rings leave your body within three days so you can get pregnant any time you stop for more than 5-7 days.

Finally, some women might wonder if it’s harmful to introduce hormones from birth control into their bodies – would it be better for them to let their bodies simply go natural? Until the past few decades, women spent much of their adult lives either pregnant or breastfeeding. Because women don’t menstruate when they are pregnant, they are having far more periods and fluctuations with their hormones today than in the past. Hormonal birth control pills, patches, and rings mimic pregnancy which actually brings the body to a more stable hormonal state.

IUDs

There are two main types of IUDs: those with hormones and those without hormones. The hormonal IUD is one of the most effective methods for preventing pregnancy, along with sterilization and the implant, with a failure rate of 0.2%. There are several different brands of hormonal IUDs: Mirena®, Liletta®, Kyleena®, and Skyla® which are usually well-tolerated as the hormone is low dose and progesterone-only.

30% of those on Mirena/Liletta have no periods – which is a big benefit for many of those with uteri – while the remaining 70% typically get lighter periods. On the other hand, women on Kyleena and Skyla are more likely to continue to have periods. Thankfully, IUDs are easily reversible so if you want to get pregnant, your fertility will resume immediately. Mirean/Liletta IUDs last for five years so, unlike the pill, you won’t have to think about it for a long time after it’s inserted.

Another option is the copper IUD which is 99% effective, lasts for 10-12 years, and can be used as emergency contraception. IUDs with copper often lead to more blood and more painful cramps during periods but some women like them because their lack of hormones makes them seem more natural. 

If you’re going to get an IUD, there are a few things you should keep in mind before your appointment. 

  1. Make sure you premedicate to avoid pain during the procedure. We recommend 800 mg of ibuprofen (Advil) taken with food to protect your stomach from the high dose 30–60 minutes before the procedure.
  2. At your appointment, ask for a cervical block, which blocks some of the pain. 
  3. Consider having the procedure done during the last few days of your period. At this time, the cervical os (the opening to the cervix) will already be open, which will make insertion easier. Some women place a warm pack on their abdomen during the procedure to relax, and even listen to music or watch a video to distract themselves.

An IUD should be covered by insurance under the Affordable Care Act – both the device and the doctor’s visit should be provided with no copay or deductible. If you are being charged for an IUD, contact coverher.org, a project of the National Women’s Law Center that gives you information on how to ask your insurance company to do what is required by law.

Natural Family Planning

For a variety of reasons, some couples might choose natural family planning. These methods do not involve hormones or medications. Instead, a woman carefully tracks the fluctuations of her menstrual cycle to understand when her fertility peaks and wanes. When done perfectly, natural family planning can be 95% effective. Because they require meticulous monitoring and strict adherence, however, the efficacy is lower in practice at roughly 77%.

As part of your monitoring, record the length of your menstrual cycle, your daily body temperature, and any changes in your cervical secretions. You can then use these indications to determine when you should abstain from sex due to the high risk of pregnancy. An advantage of natural family planning is that it avoids the side effects that come with medication, although it comes at the expense of efficacy and the ability and self-control to say no to sex during fertile days.

You should only use this method if you and your partner are committed to adhering to it, and you are comfortable with the higher risk of pregnancy. Consider talking to your doctor and reviewing medical information to understand how it is done properly.

Making #Periods Optional

Periods are optional! The only reason that the lining of the uterus is built every month and pops out an egg, a process known as ovulation, is to make a baby. On average, in the United States, girls start their periods at 12 years old and women have their first baby at 26 years old. However, if you do not want children, then why bother with getting a period?

Every time we shed our lining and pop out an egg unnecessarily, that adds to the risk of anemia as well as endometrial and ovarian cancer; that’s 14 years of monthly periods for no good reason! Thankfully, you can safely and easily stop your menstrual cycle using the ring, pill, or IUD with hormones.

Skipping your period is safe and natural. It won’t cause imbalances in estrogen and progesterone, lead to conditions like polycystic ovary syndrome (PCOS), or induce weight gain; in fact, women who skip their periods will experience less bloating, which regularizes weight. If you plan on taking hormonal birth control, be sure to consult with your doctor about if anyone in your family has had blood clots or if you have ever had them. 

Skipping periods also does not affect your future fertility. If you restart your periods after skipping them for an extended amount of time, your period will not last longer. The lining of your uterus is NOT building up when you don’t have a period while on birth control; it’s just at a steady level which is usually smaller than its level during your regular period. When you have a period off of your birth control pill, you are building the lining of your uterus to accept an embryo – so you need lots of blood and nutrients.

While this might seem like a new idea, women and physicians have been skipping periods since the 1960s. Before birth control was invented, women spent much of their adult lives before menopause either pregnant or breastfeeding exclusively so they did not get their periods. Thus, a stable level of hormones (which monophasic birth control pills help with) and skipping the week of sugar pills actually more closely mimics our natural hormone levels.

The length of time your period will disappear using a monophasic birth control pill or ring will depend on your body individually. Typically, the first time you try monophonic birth control, you won’t get a period for roughly three months; with each successive round of continuous birth control, this length of time will extend and many women will be able to get up to no periods at all. But, remember, everybody is different.

Check out “John Rock’s Error” by Malcolm Gladwell, an article explaining why misconceptions about #PeriodsOptional persists and the reason it’s unnecessary to have a period while on the pill.

Get Started with Pandia Health

If you’re ready to start your birth control journey, the expert doctors at Pandia Health are here to help. We will prescribe the safest birth control option with the least side effects based on your answers from the health questionnaire regarding your medical history, previous birth control experience, and personal preferences. To get started, sign up for our telemedicine services and get your birth control delivered for FREE.

Disclaimer: The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.