Birth Control Options
Overview of Essure procedure:
Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor’s office in less than an hour.
Trusted by women and doctors for over five years, Essure is covered by most insurance providers. If the Essure procedure is performed in a doctor’s office, depending on your specific insurance plan, payment may be as low as a simple co-pay.
Essure offers women what no birth control ever has:
- No cutting
- No going under general anesthesia
- No slowing down to recover
- No hormones
- No guessing – your doctor can confirm when you can rely on Essure for birth control
- Short procedure time – Essure only takes about 13 minutes to perform*
- Trusted by women and doctors for over ten years
*Average hysteroscope time
And you’ll never have to worry about unplanned pregnancy again. The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.
ParaGard is an intrauterine device (IUD) that’s inserted into the uterus for long-term birth control (contraception). The T-shaped plastic frame has copper wire coiled around the stem and two copper sleeves along the arms that continuously release copper to bathe the lining of the uterus. ParaGard produces an inflammatory reaction in the uterus that is toxic to sperm, which helps prevent fertilization.
ParaGard is the only copper IUD available in the U.S. ParaGard prevents pregnancy for up to 10 years after insertion.
Why it’s done:
ParaGard offers effective, long-term contraception. It can be used in premenopausal women of all ages, including teenagers. Among various benefits, ParaGard:
- Eliminates the need to interrupt sex for contraception or seek partner compliance
- Can remain in place for up to 10 years
- Can be removed at any time, followed by a quick return to fertility
- Decreases the risk of endometrial cancer and possibly cervical cancer
- Can be used while breast-feeding — though there may be an increased risk of perforation or expulsion when inserted soon after delivery
- Doesn’t carry the risk of side effects related to hormonal birth control methods
- Can be used for emergency contraception if inserted within five days after unprotected sex
ParaGard isn’t appropriate for everyone, however. Your health care provider may discourage use of ParaGard if you:
- Have uterine abnormalities that interfere with the placement or retention of ParaGard
- Have a pelvic infection, such as pelvic inflammatory disease
- Have uterine or cervical cancer
- Have unexplained vaginal bleeding
- Are allergic to any component of ParaGard
- Have a disorder that causes too much copper to accumulate in your liver, brain and other vital organs (Wilson’s disease)
- Have or are at high risk of a sexually transmitted infection, and won’t use condoms
- Had previous problems with an IUD
The IUD at a Glance
- Small, “T-shaped” device inserted into the uterus to prevent pregnancy
- Safe, effective, and long lasting
- Must be inserted by a health care provider
- Costs between $0 and $1,000 up front, but lasts up to 12 years
Is an IUD Right for Me?
Here are some of the most common questions we hear women ask about IUDs.
- How does an IUD work?
Both the copper and hormonal IUDs work mainly by affecting the way sperm move so they can’t join with an egg. If sperm cannot join with an egg, pregnancy cannot happen.
For some women, hormonal IUDs may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.
- How effective is the IUD?
Most women can use an IUD safely. But all medications have some risks, so safety is a common concern when choosing a birth control method. Certain conditions increase the risk of side effects. Talk with your health care provider about your health and whether an IUD is likely to be safe for you. There are many other methods of birth control that may be safe for you if you cannot use an IUD.
You should not use an IUD if you
- have had a pelvic infection following either childbirth or an abortion in the past three months
- have or may have a sexually transmitted infection or other pelvic infection
- think you might be pregnant
- have cervical cancer that hasn’t been treated
- have cancer of the uterus
- have unexplained bleeding in your vagina
- have pelvic tuberculosis
- have a uterine perforation during IUD insertion
A health care provider may find that the unique size, shape, or condition of a woman’s uterus does not allow correct placement of an IUD. This is not common.
You should not use the ParaGard IUD if you
- have, or may have, an allergy to copper or have Wilson’s Disease — an inherited disease that blocks the body’s ability to get rid of copper
You should not use a hormonal IUD if you
- have severe liver disease
- have, or may have, breast cancer
If you have a condition that makes it unsafe to use an IUD, don’t worry. There are many other methods of birth control that may be safe for you. Read about other methods to find one that is right for you.
- What are the benefits of an IUD?
IUDs are some of the least expensive, longest lasting forms of birth control available to women today. There are many other benefits.
- IUDs may improve your sex life. There is nothing to put in place before intercourse to prevent pregnancy. Some women say that they feel free to be more spontaneous because they do not have to worry about becoming pregnant
- The ParaGard IUD does not change a woman’s hormone levels
- Hormonal IUDs may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent. For some women, periods stop altogether
- IUDs can be used during breastfeeding
- The ability to become pregnant returns quickly once the IUD is removed
Some women may worry that they are pregnant if they do not have a regular period. But the IUD is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test.
Overall, most women who get an IUD are very satisfied with their choice.
- What are the disadvantages of an IUD?
It’s important to think about the possible side effects of using an IUD.
You may have:
- mild to moderate pain when the IUD is put in
- cramping or backache for a few days
- spotting between periods in the first 3–6 months
- irregular periods in the first 3–6 months — with Mirena or Skyla
- heavier periods and worse menstrual cramps — with ParaGard
Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider.
Serious problems with the IUD are rare. There are three main things to watch out for when using an IUD:
- The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed
- In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a woman’s ability to become pregnant in the future
- In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isn’t. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD
Most often, if complications happen, they are easy to treat with medicine or other treatments.
It’s important to pay attention to any symptoms you might have after starting the IUD. Tell your health care provider immediately if you
- find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers
- are not able to feel the string ends when you check
- feel the hard plastic bottom of the “T” part of the IUD against the cervix, when you check
- think you might be pregnant
- have periods that are much heavier than normal or last much longer than normal
- have severe abdominal cramping, pain, or tenderness in the abdomen
- have pain or bleeding during sex
- have unexplained fever and/or chills
- have flu-like symptoms, such as muscle aches or tiredness
- have unusual vaginal discharge
- have a missed, late, or unusually light period
- have unexplained vaginal bleeding
IUDs and Pregnancy
The risk of pregnancy while using an IUD is very low. But if the IUD slips out of place, pregnancy can happen. If you become pregnant, have the IUD removed as soon as you find out that you are pregnant. If you are pregnant with an IUD in place, there is an increased risk of
- ectopic pregnancy
- dangerous pelvic infection
- early labor and delivery
Even with the risks, some women may choose not to have the IUD removed during pregnancy. If you don’t want to have the IUD removed while you are pregnant, you need to work with your health care provider through your pregnancy.
Ectopic pregnancies are a serious concern. They can be life-threatening. Women who use IUDs are much less likely to have an ectopic pregnancy than women who are not using birth control. But if a woman does become pregnant while using an IUD, it is more likely to be ectopic than if she was not using the IUD.
Symptoms of an ectopic pregnancy include
- irregular vaginal bleeding
- pain in the abdomen or tip of the shoulder
- sudden weakness or fainting
If you have any of these symptoms while using an IUD, get medical care right away.
- How soon after getting an IUD can I have sex?
You can have sex as soon as you like after the IUD is inserted.
- The ParaGard IUD is effective immediately.
- Hormonal IUDs are effective immediately if inserted within seven days after the start of your period. If you have Mirena or Skyla inserted at any other time during your menstrual cycle, use another method of birth control like a condom, female condom, or spermicide if you have vaginal intercourse during the first week after insertion. Protection will begin after seven days.
- What happens when I have an IUD insterted?
To get an IUD, you need to visit a health care provider. Your health care provider will ask you some questions about your medical history and the way you live your life. It is important to be open about your sex life because the IUD may not be right for you. But don’t worry. There are many other birth control methods to choose from if you cannot use the IUD.
If an IUD seems to be a good choice for you, your health care provider will check your vagina and internal organs. You may be tested for sexually transmitted infections or for other infections to make sure it’s safe for you to get an IUD. If you have any kind of pelvic infection, you may need treatment before getting an IUD.
An IUD can be inserted at any time of the month. But it is usually more comfortable if you have it inserted in the middle of your menstrual cycle. That is when the cervix — the opening to the uterus — is the most open.
An IUD can be inserted after a pregnancy or abortion.
You can have an IUD inserted
- up to 48 hours after giving birth OR after waiting at least four weeks after giving birth. Women who are breastfeeding should wait four weeks before having a hormonal IUD inserted
- immediately after an aspiration abortion
- four weeks after a D&E abortion
- when the abortion is complete after taking the abortion pill. Your health care provider can help you decide when to get the IUD inserted
A health care provider will insert the IUD. The IUD is inserted into the uterus through the cervix using special instruments.
It is common for women to feel some cramping when the IUD is inserted. Many women only feel mild discomfort. The cramps go away after you rest, or if you take some pain medication. Some health care providers suggest that women take pain medication before the IUD is inserted to lessen the cramps. Some health care providers inject a local anesthetic around the cervix to reduce discomfort.
When the IUD is inserted, some women may feel dizzy. Rarely, a woman might faint. You can ask someone to come with you when you get the IUD inserted so you don’t have to drive or go home alone. You should plan to rest at home until any discomfort goes away.
When the IUD is in place, a string will hang down into the vagina. It will be about one to two inches long.
- What should I do after getting an IUD?
You should have a checkup after your first period. Don’t wait longer than three months after you get your IUD to make sure it is still in place. Women using an IUD should have regular checkups to make sure everything is all right. This can be done at the same time as your periodic GYN exam. Remember when you have your IUD inserted. That way, if you see other health care providers, you can tell them when it needs to be replaced. The ParaGard IUD should be replaced after 12 years. Mirena should be replaced after five years. Skyla should be replaced after three years.
If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later. The IUD is most likely to slip out of place during your period. Check your pads, tampons, or cups to see if the IUD has fallen out. If it has, you must check with your health care provider. Until then, use another form of birth control such as condoms.
Between your periods, you can check for the string ends if you want to, but do not pull on them. Pulling the strings might make the IUD move out of place or even come out.
- How is an IUD removed?
Having an IUD removed or replaced is usually simple. Your health care provider will do it for you. Women should never try to remove IUDs themselves or ask nonprofessionals to do it for them. Serious damage could result.
In rare cases, IUDs cannot be easily pulled free. In these cases, the cervix may have to be dilated and a surgical tool may be used to free the IUD. In very rare cases, surgery becomes necessary.
Birth Control Vaginal Ring (NuvaRing)
Vaginal Ring at a Glance:
- A small ring you put in your vagina once a month for three weeks to prevent pregnancy
- Safe, effective, and convenient
- Easy to get with a prescription
- Costs about $0–$80 a month
Is the Vaginal Ring Right for Me?
Here are some of the most common questions we hear women ask about the vaginal ring. We hope you find the answers helpful.
- Waht is the vaginal ring?The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. The vaginal ring is commonly called NuvaRing, its brand name.
- How does the vaginal ring work?
Like other methods of birth control, NuvaRing releases hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work.
The hormones in NuvaRing are the same hormones as in the birth control pill — estrogen and progestin.
The hormones in the ring work by
- Keeping eggs from leaving the ovaries. Pregnancy cannot happen if there is no egg to join with the sperm
- Making cervical mucus thicker. This keeps sperm from getting to the eggs
- What are the benefits of the vaginal ring?
Using the vaginal ring is safe, simple, and convenient. There is nothing to do right before having sex. Some women say it improves their sex lives because it helps them feel more spontaneous.
Many women who use the vaginal ring have more regular, lighter, and shorter periods. And a woman’s ability to become pregnant returns quickly when use of the ring is stopped.
Because the ring works like the pill, it probably offers the same benefits. These health benefits may include some protection against
- bone thinning
- bad menstrual cramps
- breast growths that are not cancer
- cysts in the breasts and ovaries
- ectopic pregnancy
- endometrial and ovarian cancers
- heavy and/or irregular periods
- iron deficiency anemia
- pelvic inflammatory disease, which often leads to infertility when left untreated
- premenstrual symptoms, including headaches and depression
- serious infection in the ovaries, tubes, and uterus
The ring can be used to control when and how often you have your period. It can also be used continuously — without a monthly break — to eliminate monthly periods.
- What are the disadvantages of the vaginal ring?
Because NuvaRing works like the pill, it probably carries the same possible disadvantages.
Possible side effects of the vagina ring
Some women may have undesirable side effects while using NuvaRing. But many women adjust to it with few or no problems.
Some of the most common side effects usually clear up after two or three months. They include
- bleeding between periods
- breast tenderness
- nausea and vomiting
NuvaRing may also cause more long-lasting side effects. It may cause increased vaginal discharge, vaginal irritation, or infection. The hormones in NuvaRing may change a woman’s sexual desire.
It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after using the vaginal ring for three months, talk with your health care provider.
After ring use is stopped, it usually takes one or two months for a woman’s periods to return to the cycle she had before using it. Once in a while, a woman may have irregular or absent periods. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before using the ring.
Regularly using oil-based medicines in the vagina for yeast infections while the ring is in place may increase the level of hormones released into the blood. This will not reduce the effectiveness of the ring. The effect of using these types of yeast infection medications with the vaginal ring long-term is unknown. Talk with your health care provider if you need long-term treatment for yeast infections while you are using the ring.
Serious side effects of the vaginal ring
Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often.
Women who use birth control with estrogen — like NuvaRing —have a slightly greater chance of certain serious problems than nonusers. The most serious — in very rare cases — may be fatal. These include heart attack, stroke, or having a blood clot in the legs, lungs, heart, or brain.
Other rare risks include developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you
- are age 35 or older
- are very overweight
- have certain inherited blood-clotting disorders
- have diabetes
- have high blood pressure
- have high cholesterol
- need prolonged bed rest
Serious problems usually have warning signs
Report any of these signs to your health care provider as soon as possible:
- a new lump in your breast
- a sudden very bad headache
- achy soreness in the leg
- aura — seeing bright, flashing zigzag lines, usually before a very bad headache
- bad pain in your abdomen or chest
- headaches that are different, worse, or happen more often than usual
- no period after having a period every month
- trouble breathing
- yellowing of the skin or eyes
The vaginal ring and breast cancer
You may have heard claims linking the hormones in the vaginal ring to breast cancer. The most recent literature suggests that the use of these hormones in birth control has little, if any, effect on the risk of developing breast cancer.
See the insert from NuvaRing for more information about possible side effects.
- How do I start the vaginal ring?
To find out what day is best for you to start using the ring, talk with your health care provider. Most often, women start using the ring within the first five days after the start of their periods. That way, they are protected against pregnancy right away. That means that if your period starts on a Wednesday morning, you can insert the vaginal ring as late as the following Monday morning to be protected right away.
If you insert the vaginal ring later than five days after the start of your period, protection will begin after seven days. Use another method of birth control — like a condom or spermicide — if you have vaginal intercourse during the first week of ring use.
The ring can interfere with the placement of the cervical cap, diaphragm, and sponge. They cannot be used as backup methods with the vaginal ring.
Starting the Vaginal Ring After Pregnancy
It’s possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women.
You can start using the ring after waiting at least three weeks after giving birth vaginally.
You can start using the ring after waiting at least six weeks if you are nursing — it may reduce the amount and quality of milk in the first six weeks of breastfeeding. Also, the milk will contain traces of the ring’s hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth.
You should wait at least six weeks after birth if you have an increased risk of blood clots. Women have a higher risk of blood clots if they
- are obese
- are over age 35
- had a cesarean section (C-section)
- had heavy bleeding after delivery
- had preeclampsia
- have certain inherited blood clotting disorders
- have had blood clots in the past
- have a close family member who has had blood clots
- need prolonged bed rest
- received a blood transfusion at delivery
You can start using the ring right after an abortion or miscarriage.
- How do I use the vaginal ring?
Most women find that NuvaRing is very easy to use. Insert one new ring into your vagina and keep it in place for three weeks in a row. Then remove it for one week — three weeks in, one week out. Insert a new ring after one week.
Here are some more specific details about using the ring:
- Store your unused rings at room temperature and out of direct sunlight
- Check the expiration date of each ring package before insertion
- Wash your hands with soap and water
- Use your fingers to press the sides of the ring together
- Gently push the ring into your vagina
- The exact position of the ring doesn’t matter
- There’s no need to remove the ring during vaginal intercourse
- Remove it in three weeks on the same day of the week that it was inserted
- Hook your finger under the forward rim and gently pull it out of the vagina
- Wrap it up in the original foil wrapper, and throw it out in the trash — do not flush. Used rings still contain some hormones. Using the foil wrapper protects children and pets who might play with a used ring. It also reduces the chance that hormones will get into the soil and water supply
- After one week without the ring, insert a new one — on the same day of the week that the previous one was inserted in your last cycle
During the one-week break, you will usually have your period. You may still be bleeding when it is time to insert a new ring. This is normal, too. But the vaginal ring must be inserted on the same day of the week as it was inserted in the last cycle, or you could get pregnant.
Some women use the ring every day without a one-week break to keep from getting their periods. They simply keep the ring in for one month, take it out, and insert a new one right away. If you use the ring continuously, it is normal to have spotting or bleeding the first six months. It may get less over time. Some women stop having any bleeding at all. This is normal and will not harm your body.
Helpful tips about using the vaginal ring
The ring will work best if you always remember to insert the ring and take it out at the right time.
A missed period does not always mean you are pregnant, especially if you have used the ring correctly. Even though the chance of pregnancy is very low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the ring.
There is a very slight chance that you will become pregnant even if you use the ring as directed. It is unlikely that using the ring during early pregnancy will increase the risk of birth defects.
If you decide you want to become pregnant, stop using NuvaRing. It’s possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before using the ring.
- What do I do if the ring slips out or I make a mistake using it?
It’s pretty common for women to make a mistake at some time when using the vaginal ring.
If you use the ring, the key to protecting yourself from an unplanned pregnancy is knowing what to do if you make a mistake or if the ring slips out of your vagina.
Pregnancy can happen if
- the ring slips out of your vagina and is not replaced within 48 hours
- the ring does not stay in your vagina for three weeks in a row
- the ring is left in your vagina for more than a month
- you forget to insert a new ring more than a week after taking out the previous ring
Here are some general instructions if any of these things happen to you. Talk with your health care provider for more information.
If the ring slips out of your vagina
- Wash the ring with lukewarm or cool water and put it back in as soon as possible.
- Use a backup method of birth control for seven days if the ring is out of your vagina for more than 48 hours.
If You Leave the Ring in Your Vagina for Longer than You Should
Up to a month after insertion
- Remove the ring
- Take a ring-free week
- Insert a new ring after the ring-free week
More than a month after insertion
- Remove the ring
- You may have become pregnant if you had vaginal intercourse more than a month after you inserted the ring. You may want to take a pregnancy test
- When you restart with a new ring, use backup birth control for seven days
When Backup Birth Control Is Needed
Use a backup method of birth control for seven days in a row
- if the ring stays out of your vagina for more than 48 hours
- if your ring-free time lasts for more than a week
- when you restart with a new ring after you left the ring in place for more than a month
Do not use a diaphragm, cap, or sponge as a backup method. The ring could keep them from being placed properly in your vagina. Latex condoms or spermicide, used separately or together, are good choices for backup protection.
You can also use emergency contraception (morning after pill) up to five days after unprotected sex. This is a great option if you had vaginal intercourse before you realized your ring was not in place or had been in place too long. The sooner you take emergency contraception, the better it will work.