Your Guide to Choosing the Right Birth Control for You
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Fitness

Your Guide to Choosing the Right Birth Control for You

The pill, the ring, IUDs -- these options will soon be free. (Yep, you read that right!) Check out the latest scoop here, and follow our guide to find the best method for you.

What You Need to Know About Birth Control

Are you using the right birth control?

The average woman uses birth control for at least three decades. So you must really like yours, right? Probably not. Seventy percent of women use a BC that they would change in some way if they could, according to a recent survey sponsored by Merck. "Maybe you started taking the pill as a teen for your acne and you're still using it, even though it's tough for you to remember it every day," says Pamela D. Berens, MD, professor of obstetrics, gynecology, and reproductive science at the University of Texas Health Science Center at Houston. Now's a good time for you to reevaluate. Beginning next August you'll no longer have to shell out a copay or meet a deductible for any FDA-approved contraception, thanks to a new federal mandate that insurance companies must pick up the tab.

Birth Control Free-for-All

What you need to know
"You won't have to pay for it, but there are a few caveats," says Dylan Roby, PhD, assistant professor of health services at the University of California, Los Angeles School of Public Health.

Know when your new plan year starts. If it's before next August, you may not get free birth control until 2013. Insurers aren't required to comply with a new regulation halfway through a policy period.

Stay in-network for your ob-gyn visit and pharmacy if you're in an HMO or a PPO. Otherwise you may be responsible for a copay or a full payment for BC if you haven't hit your deductible.

Call your insurer to check coverage. A small number of major corporations have a temporary waiver from the government. If your plan won't cover BC, contact your state insurance agency.

Choose the Best Birth Control for You

We did the homework for you. Now all you have to do is find your fit.

 
The Method: The Pill

Currently $10 to $70 a month

Best for: The Bodyguard, The Control Freak

Pros: Can take it continuously to eliminate periods, quickly reversible, benefits of certain types include improved acne, fewer headaches and painful periods, and less heavy bleeding.

Cons: Must remember to take it every day, side effects may include spotting, breast tenderness, bloating, anxiety, nausea, and decreased libido.

Effectiveness: 99 percent with perfect use, 91 percent with typical use.

The Method: The Patch (Ortho Evra)

Stick it on your arm, belly, or butt to deliver hormones that prevent ovulation. You wear one a week for three weeks and then take a weeklong break. Currently $15 to $70 a month.

Best for: The Bodyguard, The Control Freak

Pros: Have to remember to apply it only once a week, can take it continuously to eliminate periods, quickly reversible, benefits similar to the pill.

Cons: Not discreet, especially in workout wear and swimwear, can irritate skin, side effects similar to the pill.

Effectiveness: 99 percent with perfect use, 91 percent with typical use.

The Method: Vaginal Ring (NuvaRing)

A flexible ring you insert into your vagina; it delivers hormones that prevent ovulation. You wear one for three weeks followed by a weeklong break. Currently $15 to $70 a month.

Best for: The Control Freak

Pros: Have to remember to insert it only once a month, can take it continuously to eliminate periods, quickly reversible, benefits similar to the pill, and side effects may be milder.

Cons: Must be comfortable with inserting it yourself and leaving it in, can slip out during sex, possible increase in normal vaginal discharge, irritation, or infection.

Effectiveness: 99 percent with perfect use, 91 percent with typical use.

The Method: The Shot (Depo-Provera)

Your doc or a nurse injects the hormonal medicine into your arm to prevent ovulation for three months. Currently $35 to $75 an injection.

Best for: The Bodyguard

Pros: Need to remember to get it only four times a year. Reduces frequency of periods and cramps. An option for breastfeeding women and those who can't take estrogen.

Cons: Weight gain in 25 percent of users, unpredictable breakthrough bleeding, not quickly reversible (may take six to 12 months for it to leave your system), may cause loss of bone density.

Effectiveness: 99 percent without skipped appointments, 94 percent otherwise.

The Method: The Implant (Implanon, Nexplanon)

A rod that your doc inserts under the skin of your upper arm. You wear it for up to three years. Currently $400 to $800; $100 to $300 for removal.

Best for: The Delegator

Pros: Reduces frequency of periods (one in three women will stop having periods after one year), quickly reversible, an option for breastfeeding women and those who can't take estrogen.

Cons: Unpredictable spotting or prolonged light bleeding, discoloration or pain at the insertion site, side effects may include acne, bloating, or a dip in libido.

Effectiveness: 99 percent.

The Method: IUD (Mirena, which contains hormones; ParaGard, which is copper)

A small T-shaped device your doc inserts into your uterus during a simple office procedure. Currently $500 to $1,000.

Best for: The Naturalist, The Delegator

Pros: Can use for five to 10 years, patient satisfaction rates are high. Quickly reversible, Mirena is FDA-approved to treat heavy menstrual bleeding. An option for breastfeeding women and those who can't take estrogen.

Cons: Possible irregular spotting, especially during the first three to six months with Mirena; possible heavier periods or more cramping with ParaGard.

Effectiveness: 99 percent.

The Method: Condoms

They too will be available for free next August with a prescription from your doctor. Currently about $1 each.

Best for: The Naturalist, The Bodyguard, The Control Freak, The Delegator

Pros: Protection against HIV and STDs, good for backup birth control.

Cons: Need to have one available every time you have sex, not spontaneous.

Effectiveness: 18 percent failure rate in first year due to user error, breakage, and slipping.

The Method: Emergency Contraception (Plan B One-Step, Next Choice, Ella)

These morning-after pills help protect against pregnancy when taken soon after unprotected sex or birth control mishaps. Currently $20 to $60.

Best for: The Naturalist, The Bodyguard, The Control Freak, The Delegator

Pros: Can buy in advance and keep on hand for emergency use, no prescription needed for Plan B One-Step or Next Choice for women over 17.

Cons: Must take within three to five days after sex, need a prescription for Ella, minor side effects include headache, nausea, abdominal pain, and dizziness. Not ideal for ongoing BC.

Effectiveness: Reduces pregnancy risk by 66 to 89 percent.

The Method: Sterilization

Surgery or a no-incision procedure to block your fallopian tubes. Currently $1,500 to $6,000.

Best for: The Naturalist, The Bodyguard, The Control Freak, The Delegator

Pros: Permanent, highly effective.

Cons: Reversal not always successful, requires a medical procedure.

Effectiveness: 99 percent.

*All birth control methods have safety risks and possible side effects. Be sure to discuss these thoroughly with your doctor.

Sources: Pamela D. Berens, MD, professor of obstetrics, gynecology, and reproductive science at the University of Texas Health Science Center at Houston, and Abbey Berenson, MD, professor of ob-gyn and director of the Center for Interdisciplinary Research in Women's Health at the University of Texas at Galveston.

Facts About the Birth Control Pill

Q: "I've heard that the pill causes blood clots. How common is this really?"

A: "Fears about blood clots are often blown out of proportion," says Rebecca Allen, MD, assistant professor of ob-gyn at the Warren Alpert Medical School of Brown University. In June the FDA issued a warning that women taking newer brands containing the hormone drospirenone (including Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, Yasmin, Yaz, and Zarah) may have a two to three times higher risk for blood clots than women using older versions of the pill with levonorgestrel. But the odds remain extremely low. "Pregnancy and childbirth are more likely than birth control to cause blood clots," Dr. Allen notes. If you are over 35, obese, or smoke or have high blood pressure or migraines, your risk increases; ask your doc about other BC options.

A: Any birth control using synthetic estrogen, such as the pill, can affect libido. One study found that women taking oral contraceptives had four times higher levels of binding globulin, a sex hormone that reduces testosterone and can lower desire and arousal, than women who didn't use hormonal birth control. If you're on the pill or other hormonal BC and you've lost your mojo, discuss alternatives with your doctor.

Q: "If I'm on the pill, will it be harder for me to get pregnant later?"

A: No. "Once you stop taking the pill, the medication leaves your system immediately and your normal cycles should return,? Dr. Allen says. One study showed that 32 days is the median time before you menstruate again. If you have a history of cycle irregularities, keep a calendar after you stop using the pill. "If you don't get your period within three months, see your doctor," Dr. Allen advises.

Q: "Will the hormones in the pill make me run slower and kill my 5K PR?"

A: It's unlikely. In fact, surveys show that more than half of all female athletes -- and 83 percent of those who are elite-level -- take the pill. Some research has found that it improves performance by reducing PMS-like symptoms and bleeding.

The Five Biggest BC Rumors -- Busted!

MYTH: Birth control causes weight gain.
FACT: Only the shot has been linked to putting on extra pounds. In a recent study, women taking oral contraceptives did not gain more than those using a nonhormonal form of birth control. Their body fat increased and lean muscle mass decreased slightly, but researchers say this is less likely to happen in women who exercise and eat right.

MYTH: Suppressing your period is unhealthy.
FACT: "Using birth control to skip your period is safe, and it may even help protect your health," says Rebecca Allen, MD, of the Warren Alpert Medical School of Brown University. "The less frequently you menstruate because of birth control, the lower your risk of ovarian and uterine cancer."

MYTH: You don't need BC as long as you're breastfeeding.
FACT: Breastfeeding does protect some women against pregnancy by preventing ovulation, but there's no way to know if you're one of them or how long the effect will last, says Terry Adkins, MD, an ob-gyn in Nashville. Twenty percent of breastfeeding moms begin ovulating within three months of delivery, a Johns Hopkins study showed.

MYTH: Getting your tubes tied requires serious surgery.
FACT: Two in-office procedures, Essure and Adiana, take only about 10 minutes. Doctors use a catheter, inserted through your vagina, to close off your fallopian tubes with tiny flexible inserts. Your own body tissue grows around them to block your tubes.

MYTH: An IUD is an option only when you've already had kids.
FACT: The American Congress of Obstetricians and Gynecologists recently issued a report noting that IUDs are safe for women who haven't yet had children and are more effective and have higher rates of satisfaction than the pill.

Originally published in FITNESS magazine, November/December 2011.

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