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The power to choose

Options for birth control are many – and lifestyle matters

During the span of her life, the average American woman who wants children spends about five years pregnant, in postpartum or trying to get pregnant. And by the time she reaches her typical life expectancy, she would have spent approximately 30 years trying to avoid pregnancy.

Roughly 66 million women in the United States are between the reproductive ages of 13 to 44, and more than half of them regularly use, or are in need of, some form of birth control, according to the Guttmacher Institute, a New York research firm specializing in sexual and reproductive health.

Medical advances in recent years have given women more options designed to accommodate her life, lifestyle and even a propensity for forgetfulness. And while some methods are more popular with women of a certain age, what a woman feels most comfortable with remains the most important factor when choosing birth control.

To each her own

Six million Latinas in the United States use birth control, according to the Guttmacher Institute. Phoenix resident Danielle Marquez Greene, 29, is one of them. Greene has been taking birth control pills since she was 17.

“So many girls I knew were on the pill. As I got older … I just stuck with it,” says Greene, a marketing consultant.Her often hectic travel schedule made remembering to take the pill at the same time every day more difficult. Greene admits she had “a couple of scares” a few years ago.

Greene was among the estimated 43 percent of women dissatisfied with their birth control, according to a 2008 Emory University study, and decided a year ago to switch to Depo-Provera, a method injected every three months.

She says the shot relieved her of the burden of daily pill taking. Currently single, Greene has no immediate plans to start a family and wants to focus on her career.

“I like to date, and condoms are not foolproof. They help prevent disease, but they’re not always the best when it comes to preventing pregnancy. That way, I don’t have to think about it all the time,” Greene says.

After the birth of her third child, Gloria Salazar, 38, decided to go with the IUD, a plastic device placed into the uterus that prevents sperm from reaching the egg. She and her husband are “pretty sure” they do not want to have anymore children, but know they want to continue to be intimate, she says.

“It’s [a form of] birth control that lets me forget about it and it gives me peace of mind,” says Salazar, a stay-at-home mother who lives in Scottsdale. “I’m too busy and forgetful … I need something low-maintenance.”

University of Arizona student Allison Rodriguez, 21, takes the pill, the most common form of birth control. She says it’s an easy and affordable backup to condoms.

“I take it every morning with my coffee. It’s become a ritual and it’s something I’m comfortable with, like taking vitamins,” she says.

Lifestyle matters

Whatever method a woman chooses, it should best fit her lifestyle, says Dr. DeShawn Taylor, medical director for Planned Parenthood. “The less the woman has to think about her birth control, the more reliable it’s going to be,” she says.

Taylor says women should evaluate their life and seriously think about when they would like to become a parent and how many years out they want it to happen. Some mothers might want to consider birth spacing between babies and pick a method that fits with the timing of their next planned pregnancy.

And even though it is popular, the pill does require some maintenance, as do other forms of birth control that call for checkups every few months, or even every month.

When looking at the most common methods, Taylor ranks withdrawal and condoms at the bottom of the list and Depo-Provera and the new single-rod implant, which is hormonal and effective for three years, at the top.

Taylor says young women in their 20s are most likely to use the pill, while women in their 30s may also use the pill, but generally have the experience and financial means to afford the higher, upfront cost of an IUD, shot or implant.

Women who choose IUDs, fairly popular in Mexico, are usually older, in monogamous relationships or already have children, Taylor says.

Women in their 40s are comfortable using the more advanced forms, but Taylor says many at this age choose permanent birth control in the form of tubal sterilization. It’s minor surgery that can be done as an outpatient procedure and involves injecting an obstruction into each fallopian tube.

Taylor advises women make their birth control choices to fit their lifestyle, regardless of age.

“No longer are we in a time that women at a certain age should have this or that,” she says. “All options are available to women, and it’s about finding the right fit and really individualizing their control.”

What’s your plan?

Long gone are the days when birth-control options were limited to a pill or piece of latex. Today, there are a bevy of choices for women of all ages and family planning stages. Here are several options from one source, American Baby Magazine:

The Combined Pill
Cost: $15-$35 a month.
What: A daily prescription pill that contains estrogen and progestin. Traditionally taken for 21 days and then take a week off. Several new types of pills are taken continuously, so you don’t get a period.
How: Prevents ovulation and also thickens cervical mucus, which keeps sperm from joining with an egg.
Who: Any woman who wants reliable, nonpermanent birth control with little side effects. It also helps treat conditions such as fibroids and endometriosis, which can cause heavy periods.
Downside: Irregular bleeding, breast tenderness, headache and a lower libido. Most doctors don’t recommend women over 35 who have high blood pressure and/or smoke use this method, due to increased risk of blood clots. Not for breastfeeding moms.
FYI: This pill is 99 percent effective if taken on a precise schedule. That number drops to 92 percent with typical use.

The Mini Pill
Cost: $15-$35 a month.
What: A daily progestin-only pill.
How: Thickens the cervical mucus.
Who: Breastfeeding new moms. Without estrogen, it doesn’t carry the risk of decreasing milk production.
Downside: It has to be taken like clockwork. If taken more than three hours past the usual time, a backup method will be needed for 48 hours.
FYI: Like the combined pill, this pill is 99 percent effective with perfect use versus 92 percent with typical use.

Condoms
Cost: About 50 cents each.
What: A sheath of thin latex or plastic worn on the penis during intercourse; available over the counter.
How: It collects semen, preventing it from entering the vagina.
Who: Women who don’t want to take hormones, who have sex infrequently or who are not in monogamous relationships.
Downside: Many men — and women — hate condoms, because they decrease sensation.
FYI: Ideally, condoms work 98 percent of the time. In reality, it’s closer to 85 percent.

Diaphragms, caps and shields
Cost: $15-$75; diaphragm and cap last two years; shield, six months.
How: Keep sperm from joining the egg by blocking entry to the uterus when used with contraceptive jelly.
Who: Women who really don’t want to use a hormonal method or who have sex infrequently.
What: Soft latex or silicone barriers that cover the cervix and require a fitting at your doctor’s office.
Downside: Not super reliable and can’t be used if any type of vaginal bleeding is present, including menstruation. Some women who use these methods develop frequent urinary tract infections.
FYI: 94 percent effective with perfect use, but that drops to around 84 percent with typical use.

The Shot (Depo-Provera)
Cost: $30-$75 every 3 months, plus exam cost.
What: Prescription-only, injectable method of birth control that contains progestin.
How: Hormone prevents ovulation, thickens cervical mucus and alters the uterine lining.
Who: Women who don’t want to get pregnant for 2-3 years or those who can’t take estrogen, like breastfeeding moms.
Downside: Irregular bleeding may result. Can also cause temporary bone thinning; Women at risk for osteoporosis should discuss with their doctor.
FYI: Use it consistently and it’s 99.9 percent effective. If you’re late for a shot, that number falls to 97 percent.

The Patch
Cost: $30-$40 a month.
What: Thin plastic patch stuck on buttock, tummy or arm once a week for three weeks.
How: Releases synthetic progestin and estrogen, preventing ovulation and thickening cervical mucus.
Who: Busy women who want a very reliable method of birth control, but might forget to take a pill every day.
Downside: There’s a slightly higher risk of blood clots for those who use this method.
FYI: It’s 99 percent effective when used perfectly. Miss a dose? Drop to 95 percent.

The Ring (NuvaRing)
Cost: $30-$35 a month.
What: Prescription-only ring inserted into the vagina once a month; left in for three or four weeks.
How: Releases synthetic estrogen and progestin that prevent ovulation, thicken cervical mucus and thin the uterine lining.
Who: Women who really don’t want to use a hormonal method of birth control.
Downside: It’s not for those over 35 who smoke or have high blood pressure.
FYI: With perfect use it’s 99 percent effective. Doctors find it roughly 98 percent effective for their patients.

IUD (ParaGard, Mirena)
Cost: $175-500 for exam, insertion and follow-up.
What: T-shaped plastic device inserted into the uterus by the OB-GYN.
How: Prevents sperm from reaching the egg and thin the uterine lining, preventing egg implantation.
Who: Moms either done having kids or who want to space their babies at least three years apart.
Downside: Up to 10 percent of IUDs are accidently pushed into the vagina in the first year; rare reports of IUDs puncturing the uterus during insertion.
FYI: IUDs are more than 99 percent effective. ParaGard is good for a decade; Mirena lasts for five years.

The Implant (Implanon)
Cost: $300-$350 for office visit and insertion; good for up to 3 years. Can be removed sooner.
What: A matchstick-size implant inserted under skin of the upper arm.
How: Progestin prevents ovulation and thickens cervical mucus.
Who: Women who do not want to get pregnant in the near future or breastfeeding moms who want to get pregnant quickly once they stop and the implant is removed.
Downside: Not widely available.
FYI: It’s fairly new, but experts estimate Implanon is 99.9 percent effective.

See this story in print here:

This Article appears on the March 2011 issue of LPM under Health

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