How To Choose The Best Form Of Birth Control For You
Although the FDA approved the first oral contraceptive in 1960, and within 2 years of its initial distribution, 1.2 million American women were on “the pill”, many millennial and Gen Z women are second guessing their decision to stay on “the pill”. Now more than ever, we have access to a variety of methods of contraception. This includes both hormonal and non-hormonal options. Many women are questioning whether long term hormonal birth control could be impacting their ability to have children in the future and are wondering if there may be a better option.
As a naturopathic doctor, specializing in fertility, I get asked this question all the time so, today I thought I would share with you my top three favorite forms of contraceptive to help you make an informed decision that is right for you. It’s also important to remember that when it comes to contraceptives, it’s okay (and actually totally normal) to change the form of contraception you use depending on the stage of life that you are currently in. Change is normal and what may have worked during your teenager and college years, may no longer be the best option for you now.
Chances are, if you are reading this article, you are most likely looking for the most natural, but yet effective and safe contraceptive options available. But, have no fear, Dr. Zen is here! I do want to remind you that choosing your form of contraceptive is YOUR decision and it can depend on a variety of factors including: accessibility, current stage of life, comfort level, convenience, risk and efficacy. Making this decision is totally personal and there is no “wrong” decision. Unfortunately, your gynecologist doesn’t always have enough time during your annual visit to give you all the information you need to make an informed decision. Instead, oral birth control or “the pill” is often their go-to with limited information or guidance provided. My goal for today’s article is to provide you the perspective from a naturopathic doctor and share with you both the pros and cons of some of my favorite birth control solutions. So let’s dive in!
Condoms
Okay ladies, now before you roll your eyes and say “my partner won’t do it”, let’s actually talk about why condoms are on my list of favorite forms of contraceptives,as well as, some important details to know if you do decide to use condoms as your form of contraception. First and foremost, although condoms may seem a little cumbersome and let’s just say may “ruin the moment”, condoms are a great option because of their accessibility (no prescription needed) and they don’t contain hormones. The other benefit to condoms is that not only do condoms work as contraception but, they can also reduce the risk of contracting sexual transmitted infections (STIs) and HIV. They do not, however, prevent the spread of syphilis or genital ulcers, like genital herpes, which are infections that are more related to direct contact of infected tissues or mucosa. This is where talking about your sexual history with your partner is cruical. Condoms, specifically male condoms (yes, there are also female condoms too), are said to be 98% effective at preventing pregnancy when used correctly. However, according to Planned Parenthood, people aren’t perfect, so in reality condoms are most likely about 85% effective. Its also important to note that not all condoms are created equal. In fact, making sure to use fair-trade non-toxic condoms like Sustain Natural can help reduce the risk of irritation, yeast infections and were developed without interfering with the normal vaginal pH. You can also use condoms in conjunction with some of the other forms of contraception for additional efficacy and support. The biggest disadvantage of condoms include that they must be used every single time you have sex, and in order for full efficacy you need to make sure the condom is not only the right size, but that it hasn’t expired (huge problem especially in teenager related pregnancies).
Fertility Awareness Method (FAM)
Similar to condoms, the fertility awareness method is a non-hormonal contraceptive option that allows your body to cycle normally without synthetic hormone intervention. In my clinical practice, Fertility Awareness Methods are by far my preferred form of contraception. That being said, I generally recommend the Fertility Awareness Method as a form of contraception for women in a committed monogamous relationship. If you are in your early 20s and are not currently in a monogamous relationship, this may not be the best option for you as the Fertility Awareness Methods may provide you more risk than you are currently comfortable with. (The estimate rate of efficacy is about 76%). Again, this is a total personal decision, but from clinical experience, my 20 something single patients aren’t a huge fan of this option. That being said, I still encourage my 20 something patients to monitor and track their cycle not just for contraception but to better understand their particular body so they can easily detect when something isn’t right. Using a period tracking app is something I recommend to everyone, whether you are trying to get pregnant or not.
If you are considering using Fertility Awareness Methods, here is what you need to know. Fertility Awareness Methods can involve a variety of tracking tools including measuring basal body temperature (BBT), cervical mucus monitoring, as well as, the use of ovulation predictor kits, otherwise known as OPKs. I do not personally suggest tracking only your period when using Fertility Awareness Methods. This is because many apps will “predict” when you ovulate (the time you shouldn’t have sex) based on the average data collected by a variety of users, rather than providing you personalized insight. Instead, I generally suggest patients track their period, use OPKs and if they decide to have sex during their “fertile window” to use a backup contraceptive method, like condoms. The biggest advantage to Fertility Awareness Methods is that it allows you to better understand not only your menstrual cycle but if and when you ovulate. Many patients originally come to my office because they noticed irregularities in their OPK readings and realize they may not be ovulating every month. This is also the reason I love Fertility Awareness Methods for women who are thinking about having a baby in the next year. Although basal body temperature (BBT) tracking is another popular Fertility Awareness Method, it’s personally not my favorite and here’s why. Although basal body temperature tracking can be a quick and simple way of tracking for ovulation, in order for BBT readings to be most accurate you must not only use a specific BBT thermometer (your basic thermometer won’t work), you must make sure to take your BBT the moment you wake up, even before getting out of bed. It also can be influenced if you happen to have slept more warm the night before or recently got sick, so for a contraceptive option, it doesn't provide the stability and efficacy that I am looking for. You can also use BBT readers like the Ava bracelet and the oura ring, but again, if you are not trying to have a baby, it’s not my preferred method. BBT tracking is something I more commonly use with my preconception patients to help them find and track their fertile window.
Ovulation Predictor Kits, or OPKs in conjunction with period tracking is by far my favorite Fertility Awareness Methods. OPKs are at-home ovulation strips that help predict when you will ovulate. Most OPKs involve a quick urine collection. The ovulation strip is placed in the urine and will detect particular hormones, most often Luteinizing Hormone (LH), but sometimes estrogen. The disadvantage with using OPKs is that you will generally need to use them every day until you get what is known as a positive “LH surge”, this occurs when your brain triggers the release of LH, which in turn, will stimulate the ovaries to release an egg leading to ovulation. Once you have used OPKs for about 2-3 months, you will have a better idea of when ovulation likely occurs and from there, you can reduce the number of days you use OPKs and instead use them 1-2 days before your predicted LH surge. The advantage of OPKs is that they help predict ovulation which means that you will know before hand which days to either use other barrier methods, like condoms, or when to not have sex. (Please note that although you are most fertile the day of your LH surge and the following 24 hours, sperm can live in the vaginal tract for up to five days, so we generally recommend that you avoid intercourse or use other barrier methods for the full five days (3 days before and 2 days after an LH surge). OPks can also be a great method if you are postpartum and hope to have children in the future but maybe not right now. This is by far my favorite contraceptive option for moms who may want to expand their family in the next few years. Fertility Awareness Methods should also only be used if you have regular and consistent menstrual cycles (a “normal” menstrual cycle can be between 21-35 days, with your period varying by no more than 3 days). If you have irregular cycles, Fertility Awareness Methods are not recommended as a form of contraception.
Intrauterine devices (IUDs)
IUDs are medical devices that are placed within the uterus by your gynecologist. There are two many forms of IUDs, hormonal (like Mirena) and non-homormal (like ParaGard). IUDs are more than 99% effective and are a great option for my 20 something patients not looking to get pregnant anytime soon. Depending on the form of IUD, their efficacy can last anywhere between 3 to 12 years. Hormonal IUDs, specifically Mirena work by releasing a synthetic progesterone known as Levonorgestrel. This synthetic release stimulates thickening of the cervical mucus, which prevents sperm from reaching the egg for fertilization. Although Mirena does contain synthetic progesterone, it does not contain estrogen, which is thought to be a safer hormonal option compared to oral birth control which often contains both estrogen (estradiol) and progesterone. One of the most common side effects associated with Mirena is light or non-existent periods. Many women will go months without any form of spotting, which can make it extremely difficult to detect if there are any irregularities in your cycle or if you are pregnant. Some women will also report new or worsening migraines as well as a decrease in libido and vaginal dryness, which can make sex painful. Researchers are also still debating if Mirena, or hormonal IUDs have lasting impacts on fertility. For this reason, Mirena and other hormonal IUDs are not my preferred form of contraception.
ParaGard, on the other hand, is the only non-hormonal IUD currently available in the United States. The T-shaped plastic device is inserted into the uterus and contains a copper wire coil which stimulates an inflammatory reaction around the inserted device that is toxic to both sperm and egg and in turn prevents pregnancy. Once inserted, ParaGard can prevent pregnancy for up to 10 years. For those looking for a long-term contraceptive option that requires limited upkeep and surveillance, ParaGard is a great option. Unlike Mirena, which most likely results in light or nonexistent periods, ParaGard is more commonly associated with heavier periods and the onset of more menstrual cramps. If you are looking for contraceptive options that can also reduce your menstrual flow, ParaGard may not be the right option for you.It is also important to mention that researchers currently believe that ParaGard does not appear to have the same fertility concerns as hormonal IUDs, like Mirena. For that reason, ParaGard may be a good option for women looking for a long term contraceptive solution.
About the Author: Meet Dr. Zen
Alissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...
