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What are my options for birth control if I don’t want to take the pill?
If you’re looking for safe, effective contraception but a daily pill just isn’t for you, don’t worry. You’ve got plenty of options, with and without hormones — and one of them even lasts up to 10 years.
You’ve likely heard of the IUD, which lasts for 5 or 10 years depending on the one you pick. The implant, a LARC (long-acting reversible contraceptive) keeps you protected for up to 3 years. And we’re just getting started. Read on to learn about non-pill options for women, and discover which is best for your needs and lifestyle.
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Navkaran Singh Sandhu, Clinical Lead
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- IUS
- IUD (aka the coil)
- Implant
- Natural family planning
- How effective is it? More than 99%
- How long does it last? up to 5 years*
- Do you need an appointment? Yes
- How effective is it? More than 99%
- How long does it last? up to 10 years*
- Do you need an appointment? Yes
- How effective is it? More than 99%
- How long does it last? up to 3 years*
- Do you need an appointment? Yes
- How effective is it? 76-88% for 'typical' use
- How long does it last? Can be used indefinitely
- Do you need an appointment? No
Mirena and hormonal IUDs
An IUD, or intrauterine device, comes in two types: hormonal (like Mirena) and non-hormonal (like the copper IUD). So how does the Mirena work? The Mirena IUD — sometimes called an IUS or intrauterine system — is a T-shaped piece of plastic that’s inserted into your uterus. Like other hormonal birth control, it then releases hormones that keep you from getting pregnant. Mirena hormones include progestin but not oestrogen, and they’re released locally versus throughout your whole body like with the pill, which usually means fewer side effects.
Mirena insertion can be painful for some women, and your doctor might advise you to take a painkiller before your fitting appointment, or apply some numbing gel before insertion. For others, it’s about as uncomfortable as getting a pap smear. Mirena is more than 99% effective against pregnancy, and you can get pregnant immediately after Mirena removal. There are also some studies showing that it can last up to 7 years even though it’s only approved for 5 years, which would make it the longest-lasting hormonal IUD.
What are the pros?
The IUD is one of the most effective types of contraception. In fact, the effectiveness of hormonal IUDs like Mirena is over 99%. The periods you get with Mirena should get lighter over time, and stop completely for many women. And the Mirena can help with issues like endometriosis.
How long does Mirena last?
Mirena is licensed for 5 years, but studies have shown it’s safe and effective for 7 years.[2] Leading up to this time, though, you might notice a few symptoms of the hormones in your Mirena running out. This will usually feel like your period before you had the Mirena inserted: PMS, a heavier cycle or more cramping. If you think you’re experiencing signs of your Mirena wearing off, you should talk to your doctor or gynecologist. Even if it’s still effective, they might be able to recommend something to make you more comfortable.
Mirena for menopause
The Mirena IUD can be used as birth control until you reach menopause, which is usually around age 50. But it’s possible to use Mirena when you’re over 50 as the progestin component of HRT. HRT, or hormone replacement therapy, alleviates some symptoms of menopause. Taking estrogen with Mirena is necessary if you are using it for HRT.
Because Mirena can keep you from having a period and a sign of menopause is not having a period for 12 months, it can be challenging to know when to remove your IUD as you get older. Talk to your doctor or gynecologist if you have your Mirena at age 50. They’ll be able to do a blood test to check your hormone levels and see if you’re experiencing menopause.
What are the cons?
The main downside to using the copper IUD is the same as the upside: it doesn’t contain any hormones. If you don’t do well with the hormones in other birth control, the copper IUD is a great option because of how long it lasts — the only other non-hormonal options are condoms or natural family planning, which require more maintenance and aren’t as effective. However, the lack of hormones also means you don’t get the benefits of hormonal birth control like lighter periods. While the Mirena can make your period go away entirely, periods on the copper IUD are often longer and heavier. Another con to the copper IUD is that the fitting and insertion can be painful for some women.
Non-hormonal IUDs: The copper IUD
The non-hormonal IUD, also called the copper IUD, is a t-shaped piece of plastic like its counterpart the hormonal IUD. The difference is that it’s got copper wire coiled around it and doesn’t contain any hormones. So how does the copper IUD work? The magic is in the copper, which is toxic to both sperm and eggs.
The copper IUD effectiveness is over 99% when inserted correctly, and it’ll keep you safe from pregnancy for 10 years. That makes IUD birth control the longest-lasting contraceptive
What are the pros?
The biggest pro to the copper IUD is that it lasts up to 10 years. That’s longer than any other method of birth control besides something permanent like sterilisation. It’s also very effective and doesn’t contain any hormones.
What are the cons?
The main downside to using the copper IUD is the same as the upside: it doesn’t contain any hormones. If you don’t do well with the hormones in other birth control, the copper IUD is a great option because of how long it lasts — the only other non-hormonal options are condoms or natural family planning, which require more maintenance and aren’t as effective. However, the lack of hormones also means you don’t get the benefits of hormonal birth control like lighter periods. While the Mirena can make your period go away entirely, periods on the copper IUD are often longer and heavier. Another con to the copper IUD is that the fitting and insertion can be painful for some women.
The birth control injection
If you want a birth control that’s a little bit less long-term than the implant or IUD, the contraceptive injection is a great option. It lasts for 8 or 13 weeks (depending on the type you choose) and is more than 99% effective. It is usually injected into your arm but if you prefer, it can be injected into the buttocks. The most common injectable contraceptive available in India is Depo-Provera (Depo for short).
Depo-Provera lasts for 13 weeks and releases progestin, a synthetic version of the female hormone progesterone, into your bloodstream. You will need to visit your doctor each time to get it injected.
What are the pros?
One of the pros of getting the contraceptive injection is that it lasts 3 months. That makes it the longest-lasting birth control that’s not a LARC (long-active reversible contraceptive) like the IUD. It’s also progestin-only (perfect for women who can’t have oestrogen-based birth control) and can help with your period.
What are the cons?
The cons to birth control injections are similar to other methods of hormonal birth control. It doesn’t protect you against STIs and you might experience side effects like headache, mood changes and acne. These symptoms of injection should eventually become less bothersome or go away, but it’s possible they’ll continue as long as you have the injection.
The contraceptive injection can also change your period, and how this happens can be a bit unpredictable. Many women find that their periods become lighter and shorter or stop altogether, but it’s possible yours might become irregular or heavier. It can also take a long time for your period to get back to normal once you stop taking the shot.
Another downside is that you usually have to go to your doctor to get the injection. But even if you do need to make the trip to the doctor’s, it’s only every three months.
How long does it take to get periods after stopping the injection?
It can take up to a year to get your first period after stopping Depo-Provera or other birth control injections. You’re still able to get pregnant during this time, so it’s important to use another type of birth control if you want to stay protected.
Does the contraceptive injection help acne?
Although the injection can help with cramps and lighten your flow, it’s unlikely to help with acne. In fact, acne is listed as a possible side effect of Depo-Provera. There are other birth control methods that are better at treating acne, including some combination pills like Crisanta and Unwanted 21 that are approved for the purpose.
Is there a male version of the birth control injection?
There’s no men’s injectable birth control yet, but one is under development. Vasalgel, also called the male birth control gel, is a polymer gel injected into the vas deferens, blocking the flow of sperm. It’s kind of like a vasectomy but a little bit less intense.
Natural family planning
Also known as the rhythm method or the fertility awareness method (FAM), natural family planning is a non-hormonal birth control option that’s very effective if you do it right — and very ineffective if not done right.
Natural family planning involves monitoring three different indicators of your own fertility and then avoiding sex on your most fertile days, which occur around ovulation. You’ll need to track the length of your menstrual cycle, which is easy enough, but also do daily body temperature readings and analyse any changes to your cervical mucus. It can take a few months to get the hang of and we recommend visiting your doctor or gynaecologist to get a few pointers with the cervical mucus part, so you know what to look for.
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Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception, 89(6), pp.495–503.
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Wu, J.P. and Pickle, S. (2014).
Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception, [online] 89(6), pp.495–503.
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Wu, J.P. and Pickle, S. (2014).
Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception, [online] 89(6), pp.495–503.
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