The IUD is one underused — and highly effective — method of birth control. (Science Photo Library/Getty Images)
Since the Pill first swept onto the scene in the 1960s, the perception of contraception has gone from controversial to common sense. Yet many women have never advanced beyond their pill packet— even as science has proven there are a number of viable alternatives to oral contraception, some of which are actually more effective. “When you look at the methods that are used most often — the Pill, the condom — it’s only what’s popular,” said Dr. Carrie Cwiak, director of family planning at Emory University School of Medicine. “It has nothing to do with what’s most effective.”
And while the “Will it work?” question should (obviously) come first, there are also other factors to consider when picking your method: Are you willing to use a daily or weekly contraceptive? One that contains hormones? One that’s placed inside you? “There is no perfect method. So even having methods that are seldom used, like the cervical cap, in the mix is really a positive,” Dr. Eve Espey, president-elect of the Society of Family Planning. “Somebody is going to love that method.”
Following, four baby-blocking approaches you may want to consider:
LONG-ACTING REVERSIBLE CONTRACEPTIVES
Known as the “LARC” methods — or long-acting reversible contraceptives — the intrauterine device (IUD) and implant are widely considered the most effective options on the market, said Espey. Although the Pill actually works better than the IUD or implant if you use it perfectly, most women fail to take the meds exactly as instructed. Translation: When it comes to “typical” use — the way women use contraceptives in the real world — the LARC methods far outshine the Pill, which has a failure rate of 9 percent, according to the CDC.
Yet most women still opt for oral contraception over the IUD or implant. “The Pill has always been the fallback,” Espey said. “It’s time-tested, and it’s got a ton of name recognition. But the IUD and the implant are far superior.” Why? They last for years, you don’t have to remember to pop a pill on a daily basis, and there are no fatal complications (like blood clots) associated with these methods, she said.
INTRAUTERINE DEVICES (IUDs)
Hormonal IUD typical use failure rate: .2%
Copper IUD typical use failure rate: .8%
There are two classes of IUDs: hormonal (Mirena or Skyla) and copper (ParaGard). After being inserted into your uterus — a procedure that may cause a little cramping — both types act a spermicide, “so the sperm and egg don’t get together,” Espey explained. The hormonal version has a second mechanism, too: It helps thicken your cervical mucus, preventing any sperm from slipping past.
And don’t worry, there are no long-term effects on fertility: After five to 12 years — the copper IUDs last longer — your doctor simply tugs the IUD string to remove the device, and you’re able to become pregnant immediately. (Keep in mind, you can take it out at any time, if you so choose.)
Although the two types of IUDs work in a similar way, there are differences, since the copper version doesn’t contain any hormones. “It doesn’t really change your bleeding pattern that much,” said Cwiak. You may notice your periods become heavier for the first three to six months after insertion, but after that, your cycle will return to its normal pattern, she said. With the Mirena IUD, “your bleeding can go away altogether,” Cwiak said. The not-so-fun part: If you do spot, it will happen randomly — not at a predictable time of the month. “The tradeoff is that it’s significantly lighter,” she said.
Typical use failure rate: .05%
The implant is a thin rod inserted under the skin of your upper arm, visible only if you were to tightly flex your arm, said Espey, and it’s even more effective than either type of IUD. “In large-scale trials, one of which we did here at UCSF, literally no one became pregnant [when using the implant],” said Dr. Philip Darney, director of the Bixby Center for Global Reproductive Health at UC San Francisco.
What’s the secret? The implant prevents ovulation and fertilization. “The IUD doesn’t prevent ovulation, and the implant does,” Espey told Yahoo Health. “It also creates that barrier mucus, so it’s super effective.” And, yes, it’s completely reversible — you can get pregnant immediately after stopping use. The only two implants available in the U.S., Implanon and Nexplanon, last up to three years.
There is a downside, though: You may experience some irregular — and unpredictable — bleeding. “The implants have the same type of bleeding pattern as the Mirena IUDs,” said Cwiak. But with the implant, you may be less likely to totally miss your period, which is one of the draws of the IUD.
FEMALE-CONTROLLED BARRIER METHODS
Why consider a birth-control option that’s less effective than the Pill? For one, barrier methods, which physically block sperm from entering your uterus, are totally hormone-free. “Some women feel it’s a more natural method, because they’re not using any medication,” said Cwiak.
And perhaps even more important, these forms of contraception are totally female-controlled — that is, you insert them, and you take them out. “This requires a little more action on your part, which is, in part, why they’re not as effective,” she said. But barrier methods also place you firmly in the driver’s seat: You only have to remember to use them on days when you’re having sex, and there’s no relying on your partner to put it on, as with the male condom.
Typical use failure rate: 21%
Yes, the failure rate is high — but the female condom still deserves a place in women’s birth-control arsenal. You can insert one up to eight hours before getting busy — thereby eliminating any awkward talks with your partner — and, unlike hormonal contraceptives, the female condom protects against STIs, said Darney. Bonus: You can leave it on after sex, so you don’t have to rush to the bathroom ASAP.
How exactly does the female condom work? “It’s inserted just like the NuvaRing or the old-timey diaphragm,” Espey explained. “It has an inner ring that fits behind the pubic bone and covers the cervix, then the rest of the condom lines the vaginal wall.” Inserting one can, admittedly, be tough— “it’s a project,” she said. “And it can bug people to the point that they just pull the thing out and have sex anyway.”
But if you’re worried about STIs — or just don’t like the idea of a daily or hormonal method of contraception — the female condom is worth considering. Note: You can also use it solely to protect against infection if you’re on another form of birth control.
Typical use failure rate: 12%
Similar to the diaphragm, the cervical cap — a thimble-shaped cup, known as the FemCap in the U.S. — acts as a barricade inside your vagina, so sperm can’t pass through your cervix. The major advantage: You can insert it up to six hours before sex — which, again, puts contraceptive into your hands, not your partner’s — and you don’t have to remove it immediately.
Since every woman’s cervix is different — for example, women who’ve given birth tend to have larger cervixes, said Darney — you’ll have to see your doctor for a fitting (one cap lasts about two years). To amp up the level of protection it offers, you can squirt spermicide onto your cervical cap, giving you physical as well as chemical protection against pregnancy.