Knowing your birth control options

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They look like devices from outer space, but they’ve marked one giant leap for womankind. Here are the best methods for your age and life stage.

Decisions, Decisions…

When you’re choosing which birth control to use, you have a lot to think about. “Age is one of the first things to consider,” says Dr. Thomas Migliaccio, a gynecologist in Hoboken, N.J. “But you also need to factor in your menstrual and medical histories, convenience, and cost.” Generally, all the methods discussed here can be effective for most women. But to help narrow your options, these are the best bets based on what you’re probably looking for from your contraception.

In Your 20s and Early 30s

What’s on your mind

You could be looking to prevent pregnancy now but planning to conceive in the distant future. You might already have babies on the brain. Or you may be in between. In other words, you need contraception with some flexibility.

Methods to consider

* Depo-Provera

Delivered by an injection once every three months, Depo-Provera contains progesterone, which helps prevent ovulation and thickens cervical mucus to block sperm from entering the uterus. It can be a good choice for women who can’t take estrogen. This method is best for those who don’t plan to conceive soon, since in some cases it can take up to a year for fertility to return.

Benefits: The longer you’re on Depo-Provera, the lighter your periods become (some women even stop getting them). And you don’t have to take a daily pill.

Downsides: You have to visit your gynecologist every three months for an injection. Also, studies show that this method can cause bone loss over time, so you don’t want to stay on it longer than five years, says Migliaccio.

Cost: $40 to $100 a shot; may be covered by insurance.

* Birth-Control Pills

Oral contraceptives contain synthetic versions of the hormones estrogen and progesterone to prevent ovulation. “They mimic the hormones produced by your ovaries,” says Dr. Cindy Basinski, a gynecologic surgeon in Newburgh, Ind. “So your brain doesn’t signal your ovary to produce an egg.” Most pills contain both hormones. Several contain only progesterone; they’re often prescribed to women who can’t take estrogen or who are breast-feeding. Typically, you take pills that contain hormones (called “active” pills) for 21 to 24 days and placebos for four to seven days. The placebos trigger the body to bleed, as if you’re having a period (you aren’t, because you haven’t ovulated). “Continuous cycle” pills, like Seasonale, all but eliminate this pseudo-period. You take active pills for three months at a time and get a “period” four times a year. “This is safe—there’s no medical need to have a period on the Pill,” says Lauren Streicher, an assistant professor of obstetrics and gynecology at Northwestern University, in Chicago. Some women are wary of taking the Pill long-term in light of its purported link with breast cancer. But “the Pill does not appear to significantly increase your risk,” says Basinski. And those containing both estrogen and progesterone may reduce your risk of ovarian and uterine cancers.

Benefits: Lighter, regular periods (ideal for women with a history of heavy bleeding) and restored fertility as soon as you stop taking it. So, contrary to popular belief, you don’t have to be off the Pill for a few months before trying to conceive.

Downsides: The Pill can sometimes produce side effects, such as headaches or nausea, and it’s not recommended for women who have a history of blood clots or who are over 35 and smoke or are obese. And—obviously—you need to remember to take it every day.

Cost: $10 a month for a generic to $75 for a brand name; may be covered by insurance. (In August 2012, health plans will be required to cover prescription contraceptives approved by the Food and Drug Administration.)
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* Condoms

This low-tech method can prevent pregnancy—when used perfectly, that is. And therein lies the problem: “The fact is that condoms have a 20 percent failure rate,” says Eve Espey, a professor in the department of obstetrics and gynecology at the University of New Mexico, in Albuquerque. Remember the lessons from high school health class: Latex, the only material recommended for condoms, is fragile, and condoms have to be put on and taken off carefully.

Benefits: Condoms are inexpensive and don’t require a visit to the doctor’s office. They’re also the most effective way to prevent sexually transmitted diseases.

Downsides: Most experts don’t recommend them as a primary method of birth control (see: failure rate). They’re best used in tandem with another option, like the Pill.

Cost: About $8 for a pack of 12.

In Your 30s and 40s

What’s on your mind

You may not be done having babies, but since your life is probably more hectic than it was in your 20s, you might want to step up to a method that’s more set-it-and-forget-it.

Methods to consider

* Nuvaring or Ortho Evra

NuvaRing is a flexible silicone ring about two inches wide, prescribed by your doctor and inserted by you. It releases estrogen and progesterone, which are absorbed through the vaginal walls to prevent ovulation. (Neither you nor your partner should feel the ring.) Typically, you leave it in for three weeks and take it out for one to bring on a pseudo-period. Ortho Evra delivers hormones through a patch you apply to your arm, abdomen, buttock, or back. Change the patch weekly for three weeks, then go patch-free for one week.

Benefits: No daily pill. “And insertion and application are practically goofproof, so they minimize user error,” says Migliaccio. As with the Pill, fertility can resume as soon as you stop using these methods.

Downsides: Side effects can include headaches or nausea. Neither method is recommended for women over 35 who smoke or who are obese.

Cost: $50 to $100 a month (there’s no less expensive, generic version of either); may be covered by insurance.

* IUDS

Intrauterine devices have come a long way since the 1970s. “There is a mountain of data attesting to their safety and efficacy,” says Espey. The most common device, called Mirena, is made of plastic and releases progesterone, which thickens cervical mucus to block sperm. Also, the T-shaped device itself causes minor inflammation in the uterus, which prevents implantation, says Espey. Mirena can be left in place for five years. Less common is the nonhormonal copper IUD, called ParaGard, which prevents pregnancy simply by creating inflammation; it can be left in place for 10 years. IUDs are placed in the uterus at the gynecologist’s office (you might feel slight cramping), and your doctor will examine you after about a month to make sure the device has stayed put.

Benefits: If you decide you want to get pregnant, your doctor can remove the IUD and “your fertility resumes quickly,” says Basinski. And for most women, Mirena produces lighter, shorter periods.

Downsides: Some women, especially those using the copper IUD, can develop heavier periods with stronger cramps.

Cost: From $800 for Mirena and from $700 for ParaGard; may be covered by insurance.

* Implanon

This matchstick-size rod is injected into your upper arm by a doctor (  you’ll get a shot of anesthetizing lidocaine beforehand). It contains progesterone to stop ovulation and thicken cervical mucus, and it lasts for three years. (Implanon is not to be confused with the Norplant device, which is no longer available in the United States.)

Benefits: “Implanon is a very effective long-term method of birth control, because once it’s placed, you can pretty much forget about it,” says Espey.

Downsides: Side effects can include acne, weight gain, and irregular periods.

Cost: $400 to $800; may be covered by insurance.

In Your 40s and 50s

What’s on your mind

Since you’re perimenopausal, your big question is probably “Do I even need birth control?” Short answer: yes. “More than 50 percent of pregnancies over age 40 are unplanned,” says Streicher.

Methods to consider

* Any Hormonal Contraceptive

They not only prevent pregnancy but also help regulate your menstrual cycle, which can become unpredictable as your body’s own estrogen production slows down, says Migliaccio. Some doctors prefer low-estrogen pills, progesterone-only pills, or the non-estrogen Mirena for perimenopausal women.

* Sterilization

If you’re certain you’re done with child-bearing, hysteroscopic sterilization might be for you. One common procedure, called Essure, involves your doctor placing two tiny coils inside your fallopian tubes with the help of a camera inserted through the cervix. “Your body’s tissue grows around the coils in about three months, closing off your tubes,” says Basinski. The procedure takes about 10 minutes and requires no anesthesia (you may get a Valium to relax you and a shot of lidocaine to numb your cervix). After three months, you’ll need a hysterosalpingogram, an X-ray in which dye is flushed through the fallopian tubes to confirm that they are blocked.

Cost: $3,000 to $4,500; may be covered by insurance.