Birth Control that is not The Pill

As a gynecologist, I discuss birth control options with women a dozen times a day.  And I start someone on the pill at least once a week.  As a matter of fact, most patients who come to me are interested in oral contraceptives pills.  This past month, however, brought several women who specifically were looking for non-pill options.  It was in counseling these patients that I realized that a lot of women have only a vague idea of what non-pill options exist out there.  So here is the skinny on birth control that is not The Pill:

NuvaRing:  NuvaRing is a small plastic ring that is placed inside of the vagina monthly.  It works the same way as the pill, but the hormones are released from the ring slowly over the course of the month.  It stays in place for 3 weeks and is removed for the last week, which is when a period occurs.  
When I first describe NuvaRing to patients, they almost always make a face.  For some women there is an "ick" factor involved with putting the ring into their vagina.  But as I remind folks, tampons are inserted into the vagina too, and no one thinks twice about that!  
NuvaRing is great for people who can't remember to take a pill daily.  It stays in place during intercourse and isn't felt by either partner.  Most women who try NuvaRing are pleasantly surprised by how simple and easy it is to use.  Like the pill, it can be manipulated to skip cycles (just bypass the ring free week and go straight to another ring).

Intrauterine device (IUD):  IUDs are my favorite.  Why?  They are essentially foolproof.  Almost all forms of birth control work really well...if used properly.  Condoms, as a matter of fact, are 98% effective at preventing pregnancy if used consistently and correctly.  The average person, however, does not use birth control consistently and correctly.  People forget to take pills, put in rings, show up for injections or use condoms.  They just don't.
That is the beauty of the IUD.  It is a small device that is placed inside of the uterus by a physician in what amounts to a 5 minute office procedure.  One type of IUD is hormonal and lasts for 5 years.  The other is completely non-hormonal (made of copper) and is good for 10 years.  Viola!  You're covered.  No trips to the pharmacy, no refills on the pill pack, no hassle.  And should you decide to get pregnant, the IUD can be pulled out at any time and fertility returns.
IUDs are safe to use in any woman, and are seeing a renewed popularity these days.  They are long lasting reversible forms of contraception, which is what most people are looking for.  Among my ob/gyn colleagues, IUDs rank highest in personal use!

Implanon:  Implanon is the new contraceptive implant that is placed just under the skin of a woman's upper arm.  It is reversible and lasts for up to three years. The procedure to insert it is quick, and a local anesthetic is given to the skin of the arm to minimize discomfort with the insertion.  I don't use Implanon as much as IUDs, because it tends to cause irregular and unpredictable bleeding.

DepoProvera:  aka "the shot".  This injection is given every 3 months.  It works well, but has the hassle factor of having to come in to the clinic every 3 months, as well as a prolonged return to fertility once the injections are stopped.  A few years ago, there was concern raised that it causes bone loss which may or may not be reversible.  And it causes weight gain in a majority of patients.  Enough said.

Condoms:  The good old condom may be the easiest form of non hormonal contraception out there.  It is relatively inexpensive, does not require a doctor's visit or a prescription, and has a high efficacy rate when used correctly.  It also offers what no other method can: protection against sexually transmitted infections!  Alas, the condom is often misused (or not used), which leads into a common joke among doctors.
Q: What do you call people who use condoms?
A: Parents.

There are a handful of other options that I have not reviewed: patches, diaphragms, cervical caps, sponges, spermicides and the rhythm method (to name a few).  And then there are the surgical options: tubal ligations and vasectomy.  The bottom line is that birth control has to be matched to the individual and the lifestyle, and each person's situation and needs are different.  Talk to your doctor about what will work best for you.  And know that there are lots of great options out there that are not The Pill.

-Dr. Jahedi