Birth control is highly individualized. With the number of options on the market, the decision can feel overwhelming. Helping women find the right contraceptive for them is one of my favorite parts of being a midwife.
When I counsel a woman about family planning, there are several things I focus on, including her:
- Goals with contraceptive (pregnancy prevention, reduction of heavy periods or cramping, ease of use)
- Current health conditions (heart health, weight, tobacco use)
- Past contraceptive experiences (what she has used successfully before)
- Timeframe (how long the method will be used)
- Age and comfort level with different options.
It can take a few tries for a woman to find out which method works best for her. Also, her preferred choice might change as her life, relationships, and family change. By working with a provider, it’s almost always possible to find a good match.
While each person is unique, I’ve noticed some trends in terms of what women tend to be happy and comfortable with based on their age and needs.
The pill: A good intro into birth control
Oral contraceptives come in a wide variety of formulations. Some contain synthetic estrogen and progestin, and some just progestin. They can allow women to have a period (more technically, a withdrawal bleed) once a month, every four months, or never.
In addition to preventing pregnancy, birth control pills can help reduce acne, make periods lighter and more regular, and ease cramping.
Because oral contraceptives are one of the least invasive types of birth control, I’ve found that the method can be more approachable and less scary for teens. For example, if a teenage girl comes in to talk about painful periods, an oral contraceptive can be a good option.
The range of pill types available, and the fact that they have been prescribed safely and effectively for decades, can also make this type of contraception appealing to women at other ages.
Women who smoke, have high blood pressure, or get migraines with auras may not be good candidates for estrogen-containing pills.
The shot: When pregnancy is more than a year away
The birth control shot is an injection of progestin given in the provider’s office every three months. When it’s used for nine-plus months (three injections or more), there is a higher likelihood of not having a period—and it can take longer for it to come back.
While some women get pregnant quickly after this type of birth control, for others it can take up to 18 months for their cycle to regulate. That makes it less ideal for someone considering a pregnancy in the next year or two. In my practice, I’ve noticed a declining number of women selecting this option.
The implant: For dependable, longer-term protection
The implant—a small rod inserted under the skin of the upper arm—delivers a steady dose of etonogestrel to prevent pregnancy for up to three years. Women tend to like the set-it-and-forget-it aspect.
Along with an IUD, I often recommend this option to moms with infants. That way they don’t have to remember their birth control amid sleepless nights, round-the-clock feedings, and the beautiful chaos that new babies bring.
Implants can also be appealing to individuals who are squeamish about the idea of an IUD. Women should be aware that this option is associated with irregular bleeding. Because the hormones in the implant travel through the whole body, side effects can be similar to the pill.
The IUD: The longest protection for all ages
IUDs are devices that are inserted into the uterus to prevent pregnancy. IUDs containing progestin are good for 5 to 6 years, depending on the brand. The copper IUD is hormone-free and lasts up to 10 years. Periods may stop completely with a progestin IUD, whereas a copper IUD can cause them to become heavier.
Today’s IUDs are approved for women of all ages, whether or not they have had children. Because insertion and removal require an office visit, most women who get an IUD plan to keep it in for at least a year, and usually longer.
IUDs continue to gain in popularity: Younger women are choosing them to prevent pregnancy and manage painful, heavy cycles. Moms are using them between children and after they are done adding to their families. Progestin IUDs are also particularly helpful for managing the heavy periods, clots, and cycle irregularity that come with perimenopause.
The tubal: The most common type of contraception
Female sterilization is the most common type of contraception. Because the method is permanent, it’s more popular among women who are older and done having children. According to the Centers for Disease Control and Prevention, between 2017 and 2019, roughly 2 in 5 women age 40–49 (39.1%) relied on female sterilization for contraception, compared with 1 in 5 women age 30–39 (21.2%).
While tubal ligations are common, monogamous couples may also want to consider a vasectomy. Vasectomies tend to be less expensive, easier to recover from, and lower risk. Both procedures are considered safe, however there is a small risk of ectopic pregnancy with a tubal ligation.
Talk to a midwife, doctor, or provider
In addition to the contraception options above, women can also consider male and female condoms— which protect against pregnancy and STDs—as well as the ring, the patch, and more. Make an appointment with your midwife or provider to discuss your options.
Jasmin Whalen-Vu is a certified nurse midwife at Vancouver Clinic. She enjoys working in partnership with her patients, providing trusted information and inspiring them to make educated decisions about their reproductive health.
