There are three hormonal contraceptives that allow less frequent dosing and don’t require pill taking. All are combinations of estrogen and progesterone, and thus they share some side effects with oral contraceptives; ones that often improve with time are irregular vaginal bleeding/spotting, nausea, breast tenderness, and headaches. Failure rates for each are 1-2 percent per year, similar to the pill. They also slightly increase the chance of developing blood clots in the legs and lungs, a risk that is multiplied when combined with cigarette smoking.
The Nuvaring is a flexible contraceptive ring about the size of a silver dollar. It is inserted into the vagina during a menstrual period, left in place for three weeks, and then removed. Benefits include not needing an office visit and light periods. Though easier to place than the diaphragm, the Nuvaring does require a level of body comfort–not everyone is okay with the insertion of a vaginal contraceptive. However, it has the lowest dose of estrogen of any combination contraceptive and very few women have side effects.
Ortho Evra is a contraceptive patch that is applied to the skin (usually the upper buttock, abdomen, or upper back) on the first day of the menstrual period, and a new patch is applied every seven days for three weeks. The fourth week is a placebo patch and is usually when bleeding occurs. Side effects include infrequent skin irritation, patch detachment (in 2-6%), and possible increased failure rate in women weighing over 200 pounds.
Mirena is an intrauterine device (IUD) that can be inserted in a simple office procedure. It lasts for up to five years, and often dramatically decreases menstrual flow. It also has few side effects as the hormone (progesterone) is concentrated within the uterus–very little gets into your bloodstream. It is a great method as long as you are aggressive in avoiding sexually transmitted diseases like chlamydia and gonorrhea (these infections can become much worse with an IUD in place).
One of the newest birth control devices is a small matchstick-sized implant called Implanon. It is inserted just underneath the skin on your upper arm in a simple office procedure and lasts for up to three years. Let us know if you are interested in this–we would be happy to discuss it with you!
Ultimately, your goal should be a contraceptive method that is reliable, has few side effects, is easy to use, and can be quickly reversed if you desire pregnancy in the near future.
