Several newer birth control methods are available for women who want long-term, effective, convenient contraception. Many women are choosing these options instead of getting their tubes tied.
- Intrauterine devices -- Intrauterine devices (IUDs) are small plastic inserts that your practitioner places into your uterus. A plastic string attached to the device is left protruding from your cervix about an inch into the back of the vagina so you can feel with your finger to check that it is still in place. The intrauterine device used to be thought of as a post-conception method, but studies have shown that sperm typically don't make it to the egg when an IUD is in the uterus. Effectiveness is over 99%. IUDs aren't new, but newer designs have improved their safety. IUDs got a bad reputation in the 1970s because one type (the Dalkon Shield) had a string that wicked bacteria up into the uterus, occasionally causing severe infections. Currently available IUDs are much safer than their ancestors, although complications or infection can occur around the time of insertion.
Two types of IUD are available: - The copper IUD (Paraguard) may make your periods heavier or crampier than usual, so if you tend to have bad periods, it might not be a good choice for you. This IUD lasts for ten years and can be inserted after unprotected intercourse as a "morning after" contraceptive. After ten years, or whenever desired, the IUD can be removed in the office and fertility immediately returns. If birth control is still needed, another IUD can be inserted at that time.
- The progestin IUD (Mirena) releases a small amount of a progesterone-like hormone into the uterus and lasts for five years. Abnormal spotting or bleeding may be troublesome for the first few months, but once that window is past, most women have either no periods at all, or light bleeding once a month. Losing your periods on hormonal birth control methods is safe. The uterine lining is just so thin that it doesn't need to shed. After five years, or sooner if desired, the IUD can be removed in the office and fertility immediately returns. If birth control is still needed, another IUD can be inserted at that time.
- Progestin implant (Implanon) -- Implanon is a thin plastic rod that is surgically inserted under the skin of the inner upper arm. Implanon slowly releases a version of the hormone progesterone for three years. Effectiveness is 99.6%. Menstrual cycles will typically be irregular or absent; Implanon requires a minor in-office surgical procedure for insertion and removal and may cause swelling or pain at insertion site. The rod may be felt or seen under the skin. Implanon is similar to Norplant, a 6-rod system, which was taken off the market about a decade ago due to problems with removal. The single rod is designed to be easier to remove. After three years, or sooner if desired, Implanon can be removed and fertility should immediately return. If birth control is still needed, another rod can be inserted at that time.
- Hysteroscopic tubal obstruction (Essure) -- Using a telescope to see into the uterus, tiny coil-shaped plugs are inserted into the fallopian tubes through the vagina. Essure can be inserted in the doctor's office under local anesthesia and doesn't require an incision. Only a limited number of doctors are currently trained in this technique and it hasn't been around long enough to know about any potential long-term issues, but seems quite safe. Effectiveness may be as high as 99.8%. Essure requires back-up birth control for three months, and then an x-ray dye test to be sure the tubes are occluded before relying on this method as birth control. Once inserted, Essure provides permanent, irreversible birth control.
2007 Marjorie Greenfield, M.D. All Rights Reserved.
