Choosing contraception that's right for you
6/20/2019 by Dr. Emily Leasure
What are your reproductive goals? Do you want to prevent getting pregnant or has a clinician advised against pregnancy based on your medical conditions or medications? Or, do you have a condition, such as menstrual migraine headaches, that can improve with hormone medications?
It can be overwhelming to understand all the different contraception options available and know which one might be best for you. If you're otherwise healthy, reversible contraception options include:
- Copper intrauterine device (IUD) — lasts 10 years
- Levonorgestrel IUD — "Mirena", lasts five years, or "Skyla", lasts three years
- Etonogestrel implant — "Nexplanon", lasts three years
- Depo medroxyprogesterone acetate — "Depo" shot, lasts 12 weeks
- Combined hormone vaginal ring — lasts four weeks
- Combined hormone patch — lasts one week
- Combined hormone pill — daily
- Progestin-only pills — daily
- Barrier methods, such as condoms, diaphragm
You may find it helpful to meet with your health care provider to discuss these options and express your preferences about:
- Method of contraception delivery (implanted device, shot, pill, patch or ring)
- Frequency of use (daily, weekly, monthly or longer)
- Effectiveness (most are highly effective, if used as directed)
- Effect on menstrual bleeding (decreased frequency, decreased flow)
- Side effects (weight gain, mood changes)
- Effect on future fertility (delay in return of fertility after stopping the use of some products)
- Noncontraceptive benefits (reduced hormonal migraines, improved acne, reduced menstrual cramps)
As the patient, you're the expert on your personal preferences and goals. Your clinician can then provide you with the best contraception option that matches them.
When you meet with your clinician, you should provide them with a complete list of medications and supplements, and tell them about important conditions that affect which contraception methods are safe for you, including:
- Current smoking status
- History of blood clots
- History of breast cancer
- Migraine headache with aura
- Cardiovascular disease
- Autoimmune diseases, such as lupus
- Overweight/obese body mass index
- History of bariatric surgery
- Any other chronic condition for which you take a medication
Even if you have these conditions, there are safe contraception options available. Pregnancy prevention is an important discussion for women with chronic health conditions to have with their clinician, since for some of these women, a pregnancy could post a serious health risk to both mom and baby.
Finally, when discussing contraception with your provider, you should also learn about emergency contraception options, which are interventions used for pregnancy prevention when a primary method of contraception either isn't used or fails. There are many myths about these treatments, including that they cause termination of a pregnancy. This isn't true.
Emergency contraception doesn't cause loss of pregnancy that has already occurred. They should be taken as soon as possible after unprotected sexual intercourse to delay ovulation and prevent conception before it occurs.
If you want to prevent pregnancy, it can be helpful to have a prescription for emergency contraception on hand rather than waiting to request one when it's needed.
With so many contraception options available, you and your clinician can find the one that will work best for your goals and preferences.
Dr. Emily Leasure is a general internist in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She completed her MD at Emory University in Atlanta, internship at Emory University, and residency at University of Cincinnati. In addition to primary care, Dr. Leasure has a strong interest in medical education, gender issues and inter-professional collaboration and teamwork in health care.