Birth Control for the Ages
Should the birth control you use now be the same as the first method you used? You have plenty of choices, depending on your age and lifestyle.
By Gina Shaw
Reviewed By Charlotte Grayson
If you're 35, you're probably not wearing the same clothes you wore when you were 18. And if you're 18, you're probably not driving the same car you'll be driving when you're 35. So should you be using the same birth control? Maybe, maybe not.
The average American woman who wants only two children will spend at least 20 years of her life -- and as many as 30 or 35 -- trying not to get pregnant, says Jill Schwartz, MD, clinical research manager at CONRAD, a contraceptive research program of the Eastern Virginia Medical School and the U.S. Agency for International Development. "Through those years, her contraceptive needs will change. The more options available, the greater the likelihood of each woman's finding a fit."
What a (Teenage) Girl Wants
In 1997, half of all eleventh-grade girls reported having had sex, according to the CDC. What do these young women want and need in their birth control?
Although the pill is the most popular contraceptive for teenagers, they don't always use it well. "It's very hard for a busy teen to take the pill every day," says Stephanie Tiel, MD, a clinical instructor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons in New York. "Women in their 30s have an 88% 'perfect use' rate with the pill." (That means they're taking it every day at more or less the same time, as they're supposed to, and not missing pills.) "Women 15-19 have only a 67% 'perfect use' rate."
Younger women --or anyone who has trouble remembering to take a daily pill -- might want to look into new hormonal contraceptive options like the "patch" (OrthoEvra, changed weekly), Lunelle or Depo-Provera (injectable contraceptives), or the "ring" (NuvaRing, inserted vaginally and replaced about every three weeks). Because they're delivering the same hormones as the pill, safety and effectiveness rates are similar. "I think they're a great option for teens who can't remember to use a pill every day, but can change a patch every week or get an injection every month," says Schwartz.
You know what we're going to say next: condoms, a barrier method. Women in their teens are at especially high risk for sexually transmitted infections, and even if you think you're in a monogamous relationship, your partner might not. Other barrier methods for contraception include the cervical cap (cavity rim), diaphragm, spermicide, and the female condom.
In Your 20s
Some of the questions that might influence your choice of contraceptive method when you're in your 20s, Schwartz says, include:
- Are you in a monogamous relationship?
- Are you interested in having children? How soon?
- Have you already had children?
If you're monogamous and not planning to try to conceive for a year or more, you might consider an IUD. "It's a very effective method that most physicians feel is vastly underutilized," says Paula Adams Hillard, MD, professor of obstetrics and gynecology and pediatrics at the University of Cincinnati College of Medicine. There are two IUDs on the market: Mirena, which contains a hormone called levonorgestrel and has the added benefits of less cramping and lighter menstrual bleeding, and the copper IUD. Both have a good safety record and effectiveness that rivals sterilization. "It's very easy. Once it's inserted, you don't have to think about it again for five or ten years, depending on which type you're using." You can't use IUDs, though, if you have had a history of pelvic inflammatory disease (PID), sickle cell disease, or heart valve disease.
"IUDs can be removed, but they're more cost-effective the longer you use it, so it's for someone who wants to use a method for at least a few years, not someone who wants to start to conceive three months from now," says Schwartz. "Similarly, I wouldn't recommend Depo-Provera (a contraceptive injection every three months) for someone who knows they want to conceive in six months, because after your last injection it can take awhile for ovulation to return."
Another option for women who don't like monthly periods is the new "extended cycle" birth control pill such as Seasonale. The pills cut the number of women's periods to four times a year. Women take 84 active pills in a row, then seven placebo pills. In essence, "extended cycle pills" are simply regular birth control pills that you take for months without a break for your period.
These pills are a good option for women suffering from premenstrual syndrome (PMS) and other cyclic disorders, says Paul Norris, MD, a professor of obstetrics/gynecology at the University of Miami School of Medicine. Any symptoms that occur on a cyclic basis -- like menstrual migraines -- will improve from keeping estrogen levels stable, he explains.
If you're not in a mutually monogamous relationship, things haven't changed much from the warnings of your teen years: Use condoms. Scientists report progress in developing a vaginal microbicide -- a gel that prevents pregnancy and sexually transmitted infections -- but that's still down the road.
Your 30s and Beyond
By the time you're in your 30s, you probably know what contraception works for you and what doesn't. "If a woman is doing well with a given method, there's not necessarily any reason to change it, as long as she's satisfied and she understands how effective it is," says Hillard. For example, don't believe the old myth that you have to take a "rest" from the pill every few years once you've been on it awhile. "There's no evidence to say that's true," says Schwartz.
There's one exception: If you're a smoker and on the pill or other hormonal methods, once you reach 35 -- or if you develop heart problems -- you'll need to change birth control methods or quit smoking. (We recommend quitting.)
Next to teenagers, women in their 40s have the highest proportion of unplanned pregnancies, Schwartz says. "They're thinking it's not going to happen to them, but it can." So if you've finished your family and don't want more children, don't assume you can stop contraception just because you're 45. If you haven't gone through menopause, it can still happen.
In that case, should you pursue sterilization? That depends. It's the most effective contraception method out there, but you might not want to abandon the pill if it's working for you. "Sterilization doesn't offer the same benefits in terms of controlling irregular bleeding and heavy menstrual flow, which can be a particular issue for women in perimenopause," says Hillard. Besides, the pill (and, doctors think likely, the other new hormonal methods) also offers protection against ovarian and uterine cancers as well as endometriosis.
Ultimately, no matter what your age or stage of life, Schwartz says, "Educate yourself about your options and be realistic about what might work for you."
Published Feb. 10, 2003.
Medically updated May 4, 2004
SOURCES: Jill Schwartz, MD, clinical research manager, CONRAD • Paula Adams Hillard, MD, departments of obstetrics & gynecology and pediatrics, University of Cincinnati College of Medicine • Stephanie Tiel, MD, clinical instructor of obstetrics and gynecology, Columbia University College of Physicians and Surgeons • "When Teens Have Sex: Issues and Trends," A KIDS COUNT Special Report from the Annie E. Casey Foundation • "Youth Risk Behavior Surveillance -- United States, 1997," CDC.
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