What if I don't want to get pregnant?

So, I've talked about getting pregnant but I want to talk a little about what is out there for birth control options. This is by no means comprehensive but just a little overview.

First, there are different types which include barrier methods and hormonal methods. I'll first summarize the differences and then talk about each one.

Barrier methods are just that, a barrier-keeping the sperm and egg apart. This includes condoms, diaphragm, copper IUD, and sponges. Barrier methods are not usually as good as hormonal methods. The analogy would be liking trying to keep a spilled drink from dripping on your favorite purse by trying to contain the liquid vs by removing the purse. Hormonal therapy just removes the purse. Barrier methods are trying to control the spilled drink.

If you use condoms and diaphragms regularly and follow the directions they are fairly effective. You know there are pros and cons for each. The biggest point of barrier methods it that they do not control anything hormonal. They will not change your moods, treat PMS, or alter your periods.

Hormonal methods will prevent pregnancy by stopping ovulation. These include the pill/ring, the depot provera shot and the implanon. These do affect your hormones and may alter your periods, PMS and moods ( for good or bad).

The mirena is somewhere inbetween. It acts as a barrier but has some hormones that will at least affect your period. In some women it may stop ovulation and may change moods, cause acne etc., but the main effect is on the uterus.

Lastly, there are permanent methods which are all ways of blocking the tubes-tubal ligation, ariana and essure.

Barrier methods:
condoms-used at the moment, about 89-93% effective, less mess for the woman, decreased sensation for the man. Low cost.
diaphragm-put in before and taken out about 8 hours later. Best with spermacide. Buy one and reuse it.
copper IUD-placed in the office, lasts up to 10 years, can make periods heavier and crampier. 1/1000 chance of getting pregnant.

Hormonal methods:
Pills- there are many, many different pills. They will give you regular cycles and lighter periods. They can help acne and occassionally PMS. They are protective against ovarian and endometrial cancer. You can also use them to time your periods, skip periods etc. On the bad side, they can alter you moods for the worse, cause irregular spotting and make you nauseous. Each pill works differently on different women and so trying several of them may help you find the perfect one. The nuvaring is just a different way of getting the same hormones-you just don't have to remember to take a pill. I rarely see weight gain and you can get pregnant soon after coming off. If fact, in some infertility cases we use a month of pills to help increase fertility.

Depot Provera-a once every three month shot given in the office. Should make your periods disappear but may cause spotting for 3-6 months. Can increase appetite and weight gain can be a problem. Will thin your bones if used for a long time but most bone density will increase when you stop taking it. Can take some time to get pregnant after coming off. May cause some depression.

Implanon- a rod placed in the upper arm in the office. Lasts for three years. Should get rid of periods but may have spotting. Should reverse quickly but may take some time to concieve. Manufacture reports no weight gain.

Mirena- IUD placed in the the uterus. Has progesterone but it usually just affects the uterus. This causes the lining to be thinner and so your periods are light to non-existant. It shouldn't affect your moods, acne etc but it does in some women. Lasts up to 5 years. Very quickly reversible. As effective as a vasectomy for birth control. Can cause some acne and mood changes in some women. Will have spotting for 2-6 months.

Remember, hormonal problems have to be treated with hormones.

Permanent sterilization
Tubal ligation-done in the OR or post partum- effective immediately, can cause periods to be a little heavier and crampier. Requires entering into the abdomen (a little more risk to the surgery) .
Ariana/ essure- done in the OR (some MD's will do it in the office), placed by going through the cervix and plugging the tubes. No incisions required. Are not immediately effective and you are supposed to get an HSG (tubal study done in radiology) 3 months later to be sure it is effective. Not currently recommended to to other surgery with it-like an ablation- but some practitioners do.
Vasectomy-safest for the women :). Done in the office. Not immediately effective. Test for effectiveness should be done in 2- 3months.

Hope that gives you a little better understanding of what is available.