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Birth Control Briefing

Birth Control Menu continued...

How well does it work? It’s 99 percent effective with perfect use; 92 percent with typical use.

Pros:

  • Safe
  • Convenient (change it once a week for three weeks, then leave it off for a week)
  • Discreet

Cons:

  • No protection against STIs
  • Might have a higher failure rate for women weighing more than 198 pounds
  • In 2005 the FDA required the manufacturer to warn on the label that women are exposed to 60 percent more estrogen than with most forms of the pill—though it’s not clear that the extra estrogen poses extra risk. This has been the subject of much debate, and most doctors believe it to deliver a much lower dose of estrogen.
  • Carries a slightly higher risk of blood clots than the pill. But that risk is still very small: three or four out of ten thousand instead of one out of ten thousand.

The Shot
Depo-Provera injections, which contain progestin only, are given by a doctor every three months. This injection has been available since 1992 and is well studied in teens. However, I do not prescribe Depo-Provera for my patients and don’t recommend it for teens because it carries a risk of osteoporosis later in life.

How well does it work? It’s 97 percent effective. Because the shot is given by a doctor, there’s no risk of imperfect use unless you don’t show up for your shot.

Pros:

  • No estrogen-related side effects
  • Good if you just can’t remember to take a pill daily or change a patch or ring weekly or monthly

Cons:

  • You may gain about fifteen pounds (one common side effect, and a big deterrent for my patients!) and it might cause acne and headaches.
  • Requires shots every three months
  • Injected hormones can lead to a temporary thinning of the bones, so most women shouldn’t use the method for longer than two years. The shot carries an FDA warning against its increased risk of osteoporosis.
  • Potential for heavy bleeding and irregular spotting

The IUD
This small, T-shaped plastic device inserted by a doctor in the uterus is now available for teens. The IUD works by preventing fertilization and implantation. Although some IUDs were taken off the market back in the

1970s and 1980s, in recent years IUDs have become one of the most popular types of reversible birth control worldwide. One type, Mirena, releases progesterone and prevents pregnancy for five years. The other type, Para- Gard, contains copper, which helps prevent fertilization, and can be left in place for ten years.

A generation ago old-school doctors wouldn’t even consider using an IUD for a teenager (or even for an unmarried woman). That’s because the devices available back then had a high risk of causing a uterine or pelvic infection, which could affect your fertility. Back then the strings attached to the little IUD device were made of a material that was super-easy for bacteria to grab onto and climb up into the uterus, where they caused infections. Today those strings are made of a different material, and the bacteria slip off more easily. The risk of pelvic infection still exists, but it’s much lower than it used to be—so low that gynecologists who treat a lot of adolescents now feel comfortable prescribing IUDs even for teens. This isn’t the right choice for every teenager, but it’s another option—as long as you understand that with this device in your uterus practicing safe sex is even more critically important!

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