By Emily Rogan
Your youngest child's in middle school; your oldest is heading to college soon. Let's face it-you're done with diapers. But be warned: If you're not postmenopausal and aren't consistently using birth control, you could still get pregnant. "If you're having periods, you better worry about getting pregnant, and that's the bottom line," says Michelle Curtis, MD, an associate professor of obstetrics and gynecology at the University of Texas-Houston Medical School. Consider this: Almost half the pregnancies in the United States are unintended, and about 20 percent of those are to women who have already reached their planned family size. The good news is that you have more choices than ever when it comes to pregnancy prevention-and some of them even offer additional benefits, such as alleviating some of the discomforts associated with heavy periods, cramping or hot flashes. Read on to find out which method is right for you.
"I can barely remember to feed my kids in the morning, let alone use birth control."
Your best bet: Intrauterine device (IUD)
There are two types of IUDs commonly used: Mirena and ParaGard. Mirena is a levonorgestrel device that slowly releases a low dose of progestin into the lining of the uterus. Your doctor inserts it in one office visit; it's immediately effective and lasts for five years. ParaGard is a copper
device that creates a hostile environment for sperm. Also inserted in the doctor's office, ParaGard lasts for 10 years. IUDs require zero compliance on your part and have a 99 percent efficacy rate. However, Mirena does more to reduce heavy periods over time, while ParaGard actually can cause more bleeding. According to Alfred Yuzpe, MD, professor emeritus of obstetrics and gynecology at the University of Western Ontario, Mirena reduces blood loss by 85 to 97 percent; he also notes that 40 percent of women will have no period after using Mirena for one year. Both IUDs could, in theory, take you right through menopause, as there is a very low rate of expulsion.
Downside: Some women experience breakthrough bleeding and cramping during the first three months as their bodies adjust.
Photo: Dorling Kindersley/Getty Images
"My period is heavy every month and I suffer from debilitating cramps and/or night sweats."
Your best bet: The Pill
According to Shari Brasner, MD, an assistant clinical professor at Mount Sinai School of Medicine and a private practitioner in New York City, the Pill provides everything from cycle control to suppressed menses, as well as "shorter, lighter, predictable and less crampy" periods. There are many brands on the market today, most of which are low-dose combinations of progestin and estrogen. "For a healthy woman" the Pill has more benefits than risks," says Dr. Curtis. "Eighty-five percent of North American women will suffer from hot flashes, not just during, but before menopause. The Pill will help lessen that and make you feel more on a normal course while you're getting contraception," she adds. The Pill also tends to control "functional" cysts-a common type of ovarian cyst, adds Dr. Brasner, and is also proven to significantly reduce the risk of endometrial, uterine and ovarian cancers in users. "If there's no contraindication of use, a woman can take the Pill until she's menopausal," notes Dr. Yuzpe. The Pill's efficacy rate, when taken consistently, is just above 99 percent.
Downside: Women over 35 who smoke, have active breast cancer, liver disease or a history of blood clots are not candidates for the Pill. And compliance is everything-you have to use it every day for the Pill to work.
"I've gained quite a bit of weight as I've aged."
Your best bet: Depo-Provera
An injection of synthetic progesterone given every three months, Depo-Provera is known to reduce periods and the pain associated with cramping as well as decrease your risk of certain cancers. Efficacy rate is around 97 percent. If you're overweight, stay away from the patch and implantable contraceptives, since research has shown they have a higher failure rate in heavy women. Some data also suggests that overweight women have a higher failure rate with oral contraceptives, in which case Dr. Brasner says she would recommend a higher-dose Pill. Barrier methods and IUDs are viable options, but diaphragms need to be refitted and checked with weight gain and loss.
Downside: You need to go for shots every three weeks, and there's a possibility of further weight gain.
"I'm divorced and have recently re-entered the dating scene."
Your best bet: Condoms used in conjunction with over-the-counter spermicidal barrier methods such as the sponge, vaginal film, jelly, foam and suppositories.
A recent study found the number of cases of sexually transmitted diseases (STDs) in people 45 and older more than doubled between 1996 and 2003, a staggering figure that shows how much things have changed since the last time you were single. The one thing that hasn't change is that only condoms will protect you from STDs and HIV/AIDS. The efficacy rate for this method is lower than other methods; however, that rate improves when spermicides are used in combination with a condom.
Downside: Some barrier methods can be messy and inconvenient to use, affecting compliance.
"I don't want to think about birth control again-ever."
Your best bet: Permanent contraception
One option is tubal ligation (commonly known as "tube tying"), a laparoscopic procedure that requires anesthesia. Your fallopian tubes are burned, clipped or tied off with a ring to occlude them and prevent sperm passage. Another option is Essure or Adiana, which are less-invasive methods that achieve the same result. Essure involves the insertion of coils into the fallopian tubes, causing scarring that will permanently block the tubes. Adiana applies heat to a small section of the fallopian tubes before inserting a small silicone, rice-sized object that blocks the tubes. For both methods, you need to have at least one follow-up visit three months after the initial procedure, so your doctor can ensure the tubes are fully blocked. Before then, you need to use another method of birth control.
Downside: Both methods are more complicated than other forms of birth control. And while they are both very effective methods, Dr. Yuzpe notes that "your hormones are untouched…you've taken care of the contraception but not the other problems that come from getting older and perimenopause."
Photo: Jupiterimages/Getty Images
"I'm nervous about using hormones at my age."
Your best bet: Condoms, spermicidal barrier methods or ParaGard IUD
Keep in mind that many experts find their patients' fears regarding hormones are unfounded. "The word hormone has been laden with negative connotation and emotional baggage, and it's just a shame," says Dr. Curtis. She emphasizes that hormones help regulate the subtle changes that start in women's bodies during their 40s and go on through menopause. Whatever your choice, be sure to discuss it with your doctor. "Women need to be their own advocates," says Dr. Yuzpe, "but they must also listen to the recommendation of their healthcare providers as to whether their choice is appropriate."
Original article appeared on WomansDay.com.
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