Contraceptive Options

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Q:

I'm 42, and I'm tired of taking birth control pills. I'm happily married and done with childbirth. What are my options? Any reason why I shouldn't switch?

A:

Absolutely not. And the beautiful thing is, you have so many other options. The most common option for women at your age is permanent birth control or sterilization. You have three possibilities:

• Permanent birth control procedure, the newest form of permanent contraception; also called fallopian tube occlusion. The U.S. Food & Drug Administration has approved a system of nonsurgical permanent birth control called Essure. It is a nonsurgical, minimally invasive procedure that can be performed in your doctor's office with a local anesthetic. The doctor uses a special instrument called a hysteroscope to place tiny spring-like coils through your vagina and cervix into the opening of your fallopian tubes in your uterus. Within three months, the inserts cause your body to form a tissue barrier that prevents sperm from reaching the egg. During this three-month period, you need to use another form of birth control. After three months, the doctor performs a special x-ray to make sure your tubes are completely blocked. Essure may reduce the risk of tubal (ectopic) pregnancy compared to tubal ligation, but there is still a small risk. Mild pain may occur immediately after insertion. Typically, women are able to return to their normal activities within a day or two. In part because of consumer complaints, in 2016 the FDA ordered changes in the package labeling for Essure to include a boxed warning and a "patient checklist," both designed to ensure that women understand the risks and benefits of the device. The FDA is also requiring the manufacturer of Essure to conduct a clinical study to determine risks of Essure for particular women. Be sure and talk with your health care provider about any potential risks and benefits to you.
• Vasectomy, in which your partner's vas deferens, the tube through which sperm travels from the testicle to the penis, is tied or cut.
• Tubal ligation, in which your fallopian tubes are blocked with a ring or burned or clipped shut. This procedure is typically performed under general anesthesia in a hospital. Risks include pain, bleeding, infection and other postsurgical complications, as well as an ectopic, or tubal, pregnancy.

All forms of sterilization carry a failure rate of less than one pregnancy per hundred women (less than one percent).

The IUD, either with or without hormones, is another long-term, but not permanent, contraceptive option. One type of IUD continuously releases progestin called levonorgestrel and can remain in place five years or longer. One advantage for perimenopausal women is that it significantly reduces bleeding from your period or stops bleeding altogether. The only major side effect is some irregular bleeding. A copper IUD may also be an option. Depending on the type of device, the copper IUD can be left in place for up to 10 years. But, if you have heavy or painful periods, the copper IUD isn't for you. IUDs are more than 99 percent effective at preventing pregnancy.

The vaginal contraceptive ring, called NuvaRing, is another hormonal-based birth control option that you might not have heard of but might work for you. You insert NuvaRing into your vagina like a tampon, where it releases a steady amount of estrogen and progestin throughout the month. You wear it for three weeks, then take it out for a week and have your period. Then you insert a new ring. Side effects include hormone effects similar to those from the pill and a mild increase of vaginal discharge. As with oral contraceptives, NuvaRing may increase the risk of blood clots and stroke, primarily in women who smoke. NuvaRing is 91 to 99 percent effective when used consistently and correctly as directed.

Of course, you can choose barrier methods, such as a diaphragm, cervical cap or condom. The benefit of these options is that you only use them when you're having intercourse, so they don't have any effect on your body at other times. Barrier methods are between 81-90 percent effective; using spermicidal jelly or cream with these methods increases their effectiveness.

Here is a birth control guide from the U.S. Food & Drug Administration showing the types of FDA-approved birth control, along with their effectiveness, method of use and some risks and side effects.

As you can see, you have a variety of options available to you in this time of your life. I suggest you make an appointment with your health care professional to discuss which one is right for you.