Uses, Risks, and Benefits of Non-Pill Options

You don’t have to take a pill every day. There are birth control methods that last for weeks, months, or even years with little effort on your part – and without surgery. They are safe and effective for most healthy women.

Which one is right for you?

“The best method of birth control for any woman is the method she will use correctly and consistently,” says Elizabeth Micks, MD, MPH, acting assistant professor of obstetrics and gynecology at the University of Washington Medical Center.

Find out what’s available, what’s involved, and how well each is working.

The IUD

This is a small T-shaped device that your doctor places inside your womb, or uterus, after you have had a checkup. It can stay there from 3 to 10 years, depending on its type.

Once the IUD is in place, you do not need to do anything else to prevent pregnancy. They are 20 times more effective than pills, patches or rings. Less than 1 in 100 women become pregnant in their first year of IUD use.

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Your doctor can easily remove it if you decide you want to get pregnant or no longer want to use it.

Hormonal IUDs are made of plastic and release the hormone progestin. This thickens the mucus in your cervix (lower part of your uterus), which prevents sperm from entering. It also thins the walls of your uterus. This prevents a fertilized egg from attaching to it, which is part of pregnancy.

Four brands of hormonal IUDs are available: Kyleena, Liletta, Mirena and Skyla. They all depend on the same medicine, called levonorgestrel. Liletta and Mirena last six years. Kyleena releases the lowest dose of hormones for the longest period of time. It lasted five years. Mirena can also reduce heavy menstrual bleeding by up to 90% after the first 6 months.

“It’s so effective in treating women with heavy bleeding, painful periods, even women with endometriosis. [a disorder of the uterus]fibroids [noncancerous tumors], and other issues, ”Micks says.

The downside for some women is going through those first 6 months. “Hormonal IUDs can lead to a lot of irregular bleeding at first, which for a lot of women is really not acceptable,” says Micks. “Women don’t like bleeding (light bleeding between periods).”

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Copper IUD are hormone free. Copper works as a spermicide and prevents sperm from fertilizing an egg. If an egg is fertilized, it can prevent an embryo from implanting.

Women who want a hormone-free form of birth control (which means fewer potential side effects) often choose these devices. Birth control without hormones, however, does not have the same effect on your menstrual cycle.

“This is not true for all women, but in general, periods can be a little heavier and more cramping with the copper IUD,” says Micks. “This is not a method we would choose for a woman who already has a heavy period.”

Birth control implant

Your doctor inserts this small, thin, flexible plastic rod into your arm. It is the size of a match. Like a hormonal IUD, the implant releases progestin into your body. It works for up to 3 years and your doctor can remove it any time before that.

Like IUDs, implants are also 20 times more effective than pills, patches, or rings.

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Some women have irregular bleeding for the first 6 to 12 months. For the most part, periods are getting thinner and happening less often.

“What comes with the implant is that it is very unpredictable,” says Micks. “Some will stop having their period, but others will have a little more bleeding.”

With her patients, says Micks, “if they don’t see themselves wanting to get pregnant within a year, I recommend that they get an IUD or an implant,” she says. “They can have it withdrawn at any time, even a day later, a month later, at any time.”

The shot (Depo-Provera)

This method protects against pregnancy for 3 months at a time. He uses a progestin to do this.

Only 1 in 100 women who get vaccinated every 12 weeks will get pregnant. For those who do not get the vaccine on time, 6 out of 100 will get pregnant.

Similar to other progestin-only methods, the injection may cause irregular bleeding during the first year. About half of women will have fewer and lighter periods afterward. Others may have heavier and longer periods or periods.

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The injection may cause the bones to thin, which stops after the injection is finished. For this reason, women at risk for osteoporosis should use a different form of contraception.

If you want to use the vaccine for more than 2 years, you should talk to your doctor about the risks and benefits of continuing it. Women with breast cancer and those taking medication for Cushing’s syndrome (a condition caused by exposure to high levels of cortisol) should also not have it.

Some women may not want to be vaccinated because they need to see a doctor every 3 months. In some areas of the United States, women can get a prescription for an injection they give themselves. If giving yourself an injection makes you squirm, check if there are any convenient places to get it – like a local health center – before you decide.

If you want to get pregnant in the next year, you may want to consider other methods of birth control. It may take 10 months or more to become fertile again after stopping the vaccine.

Combined birth control

Like most birth control pills, the patch and ring prevent pregnancy using progestin and estrogen hormones. You use the patch and ring for 3 weeks, then stop for one. During this “week off” you have your period. Some women who want to stop their periods completely don’t take a week off.

Women who take the fourth week off often have a lighter period with fewer symptoms.

You need to change your patch or ring in time. Nine out of 100 women who do not use them as directed become pregnant.

Like the pill, the patch and ring may increase your risk of blood clots. They are not recommended for women with risk factors for stroke, blood clots, or heart disease, such as women over 35 who smoke.

The patch is a thin, beige plastic sticker that you wear on your skin anytime for a week. You glue it on the outside of your upper arm, back, behind, or belly. You replace the patch every week for 3 weeks, then usually take a week off.

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Some women complain that the patch falls off or irritates their skin where it is applied.

The ring is another option. Sold as Annovera or NuvaRing, it is a small ring that you insert into your vagina, similar to a tampon. You leave to act for 3 weeks. After that, you take a week off to allow yourself to live a period. With Annovera, you then reinsert the ring. With NuvaRing, you insert a new ring.

It is possible that the ring will fall off before it is time to change it. If this happens, rinse it and put it back. If it is broken, you need to insert a new one.

The patch and ring are not as effective as the pill, IUDs, implants, or injections. But some women still use the patch and ring, Micks says, because they feel more in control of a method they can stop at any time without a doctor’s visit.

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