Sex & Relationships

Unhappy With Your Birth Control? 10 Methods You May Want to Try

Birth control can be a pain, but in this day and age every woman should love her method. Here are 10 you ought to consider.

Of all the relationships in my life, the one with my birth control has been one of the most tumultuous. Over the years I've tried five different kinds, and while I am happy to report that I've finally found one that works for me, it was a bumpy path getting here.

My most devastating birth control experiment was one of my first, which lasted nearly four years. It wasn't until I was off that particular method that I realized I'd just stepped out of a four-year haze that had been characterized by angry, irrational outbursts book-ended by episodes of equally irrational, very weepy sadness. (Apologies to my incredibly supportive college boyfriend.) Indeed, it wasn't until I was off that birth control that I elatedly discovered I wasn't the terrifying ball of fury and tears I thought I'd become. It was the birth control.

It sounds silly now, but not once in those years did I consider that perhaps the little pill I took every day had changed my personality. After all, the doctor who'd prescribed it to me told me it was low on hormones and just generally low on negative side-effects. And she'd kind of scared me away from every other option I'd read about.

Today I have found peace with my IUD, or intrauterine device. I couldn't be happier; we've been together for nearly three years. But when I was considering the IUD, some friends told me scary stories, and different doctors told me I'd be barren if I tried it. Fortunately I did my research and found a health-care provider who dispelled the many myths, but the process got me thinking about all the misinformation out there about birth control.

Sex educators know this all too well. Heather Corinna, who founded Scarleteen.com, a sex-ed site for teens, and runs a sex-ed program in Seattle, has heard all kinds of far-fetched stories about birth control methods. A lot of this could have to do with the fact that many women get their contraceptive care from general practitioners rather than ob/gyns, she says, some -- not all -- who may have less specialized training. Indeed, both GPs and gynecologists may not have up-to-date training in contraception, which may be why many of them tend to avoid the "newfangled" methods now available.

And of course there's the whole issue of our for-profit health care system. "Some of these methods -- most but not all of them -- are for-profit ventures, so a lot of times you'll get offered methods that have more marketing dollars attached to them," says Corinna. "For example, cervical barriers have no marketing, basically. There's no big profit margin there because you buy one and have it for five years or more. Compare that to pills, which guarantee a constant influx of cash."

No kidding. Then there's the fact that many, if not most, women put a lot of stock in others' anecdotal information. "Since people don't have conversations with hundreds of women, the information they receive isn't really representative," Corinna points out.

So you hear one person say she got pregnant on method X and you're turned off X, despite the fact that no birth control method out there is 100 percent effective even with perfect use. You may be similarly swayed by someone like me, now an IUD evangelist, who has no complaints, only praise to offer. Ask someone else and you may hear something very different.

We also often forget that birth control methods, like all medication, have inherent risks. My gynecologist assures me that as long as your provider pays attention to your needs and concerns, and has a good understanding of your medical history, most of the scarier risks are avoidable.

Recent class-action lawsuits -- mostly aimed at the newer methods -- have also caused people to stay away from less-established forms of birth control. But Corinna dismisses these lawsuits as "ambulance-chasers 2.0." After all, she says, "even Advil has a lot of fine-print side-effects." And yet most people use Advil regularly, with little to no side-effects.

Every woman should love her birth control. And finding the one that's right for you is -- as with human sexual partners -- a matter of weeding through, doing research, and trying out a few, before you eventually find your perfect match. In the spirit of greater transparency, and armed with the belief that no woman need rue the day she started protecting herself against unplanned pregnancy, here are 10 birth control methods you may not have heard of. Read through the pros and cons, and learn what your doctor will -- and won't -- tell you about them.

1. Cervical barriers

When people think of barrier methods, they often think of the male condom. But they're leaving out a whole slew of barriers contained entirely within the vagina. Cervical barriers include the diaphragm and the cervical cap. (As well as Elaine Benes' favorite, the contraceptive sponge.)

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How they work:
There are several kinds but let's delve into two of the most common. The cervical cap is the smallest among cervical barriers. Most of these use suction to stay in place, be it on the cervix or on your vaginal walls. And of course there's the diaphragm, which sits behind the pubic bone and has a firm but malleable ring that  allows it to press against the vaginal walls and do its thing. Almost all cervical barriers have to be fitted by your health-care provider and must always be supplemented with spermicide.

Pros:
You can put in your cervical barrier of choice up to two hours before intercourse, so you don't have to stop foreplay to worry about insertion. They are cost-effective because they are washable and reusable -- you can get away with using one for a few years! If you want to have sex while you're on your period, this is a relatively easy way to reduce the chances of a bloody stain on your sheets.

Cons:
It can take a bit of practice to put in (not unlike the first time you used a tampon or a menstrual cup), and you need to leave the cervical barrier in your vagina for six to eight hours after intercourse.There may be an increased risk of bladder and urinary tract infections. Some male partners report feeling the cervical barriers during use.

What you should know:
Some doctors will just figure these are really old-school and most people would prefer something hormonal or that doesn't require insertion upon each use. And some doctors may not be trained to fit a cervical cap or diaphragm -- but that doesn't mean one may not be right for you.

2. Female condom

Get ready to hear a lot more about this one. Another barrier method, female condoms (or FCs) have been underused for a long time, but they just received a full-on makeover. A smoother, softer, more affordable ringed version was recently approved for the market by the FDA.

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How it works:
Just insert into your vagina (or anus) and you're ready to go. The female condom is lubricated, and shaped like an open-ended tube, with a removable inner ring and an attached outer ring. The inner ring stays in the back of your vagina. When used for anal sex, the inner ring can be left in, or taken out, depending on your preference. The outer ring then covers the surface area around the vaginal or anal opening, providing increased protection against STIs that are spread by skin-to-skin contact.

Pros:First off, this is the only condom controlled by the receptive partner -- the woman. Unlike male condoms, it is unlikely to come out during intercourse. It's hypo-allergenic which is great for those who can't use latex. FCs also adjust to body temperature so you and your partner both feel the heat. You can put it in hours before having vaginal sex, which means you don't need to interrupt foreplay. FCs don't require an erect penis, and you can use it for both vaginal and anal intercourse. Not only will this method prevent unwanted pregnancies, it also blocks out STIs and HIV.

Cons:
They're more expensive than male condoms and can be tougher to find, though this may change as the new FCs grow more popular.

What you should know:A lot of doctors don't even bring up the FC when birth control methods are being discussed. Further, they might remember the older sandwich-bag version of the female condom, so they may not look kindly on the new, improved version.

3. The Patch

We've all heard of the nicotine patch, which helps cigarette addicts wean themselves off their fix, while still providing them the nicotine they need. The contraceptive patch works much the same way, slowly applying the anticonceptive dose you need through your skin.

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How it works:
Much like a band-aid, you stick the adhesive patch somewhere on your body -- arms, hips, bums are most popular; anywhere but the breasts works -- and you receive ovulation-suppressing hormones transdermally. Every week for three weeks you switch your patch out for a new one; on the fourth one, you take a break. The hormones in the Patch match most of those in the Pill.

Pros:
Lots of women have lighter periods, less cramping and diminished PMS symptoms.

Cons:
Use is contraindicated for smokers and women over 35. Diabetics, breast-feeders and those who suffer high blood pressure ought to avoid the Patch. And some not-so-great side-effects include vaginal dryness, yeast infections, breast tenderness, and possible weight gain. The Patch does fall off more than advertised, particularly if you use a lot of body lotion. It is slightly more expensive than the Pill, averaging $35-50 per month. It does not protect against STIs.

What you should know:There's slightly more estrogen than in other birth control methods. This is good to know, especially if a woman is particularly concerned with hormonal side-effects.

4. The Ring

Here's one way to think of your birth control method only once a month. Put a ring on it, ladies!


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How it works:It's a plastic ring that you put inside your vagina (as far up as you can manually manage) that releases hormones that prevent pregnancy. You replace it once every three weeks, and go one week without. After that last week, you put a new ring in.

Pros:
The Ring delivers a lower dose of estrogen than both the Pill and the Patch. Most people don't feel the Ring during intercourse, but if you do, you can take it out for up to three hours for some unencumbered fun before replacing it. Shorter, lighter periods; less cramping and PMS. Oh, and of course: you only have to think about it once a month!

Cons:
Some women report increased vaginal irritation, odor, imbalances, lubrication or infections. If you don't put it in right, it can fall out, though this usually happens only to newbies. Women who are over 35, have high blood pressure or cholesterol, are breast-feeding, suffer from depression, have migraines, and/or are smokers should avoid the Ring. This method does not protect against STIs.

What you should know:Doctors may gloss over the fact that it is indeed OK to take it out during sex -- because they worry you'll forget to put it in within three hours of taking it out. You might expect to add more lube than you've ever used before, too.

5. The Shot

If once a month isn't good enough for you, try once every three months. Leave your birth control in your health-care provider's hands, with this hormonal birth control delivered much like the vaccines you've been getting your whole life.

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How it works:
The Shot is a progestin-only form of birth control, meaning it contains no estrogen, which some women prefer. Just go to your health-care provider once every three months for a shot, and you're protected from unintended pregnancy 24/7.

Pros:
Proper use isn't really an issue here, as long as you keep your appointments with your health-care provider, which makes the Shot one of the most effective birth control methods. Further, the Shot may decrease cramping and menstrual bleeding and rarely negatively interacts with other medications. It's great for women who haven't enjoyed estrogen-based birth control side-effects.

Cons:
May cause bone loss over a long period of time, which means you shouldn't use the Shot for very long-term use. Most report weight gain; and those who already suffered depression say those symptoms can be aggravated by the Shot. Irregular bleeding or light spotting is possible. Women who are breast-feeding shouldn't use this method.The Shot does not protect against STIs.

W
hat you should know:If you try the Shot once and never get a second injection, the effects may be with you for up to six months or longer. If you want to do the Shot but have never tried a progestin-only birth control method, try the "minipill" first, so you can make sure to avoid bad side-effects for such a long time. And if you care about this sort of thing, the average weight gain here is serious: 11 pounds. Finally, it's suggested you take a break from the Shot every three years.

6. Continuous Birth Control

For eons, women have had their periods about once a month. For just as long, women have wished that could change. With continuous birth control, monthly periods can be a thing of the past.

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How it works:
First some background: when women have periods on the Pill (and other forms of synthetic hormone-based birth control methods), they're not actually periods, they're withdrawal bleeds. So with continuous birth control you're skipping the placebo period that would usually create the bleeding. You can achieve continuous birth control either by skipping the placebo week with regular birth control methods such as the Pill, or you can use pills expressly designed for continuous use and period suppression, which may give you a period only four times or even just once a year.

Pros:
For women with particularly heavy or lengthy periods, or lifestyles greatly complicated by regular periods, continuous birth control can be a game-changer. Some research even suggests that women weren't designed to have periods for as long as we do these days, given how long we live -- so cutting down on your menstrual cycles could cut down on the stress placed on your reproductive system, reducing the risk of ovarian and other cancers.

Cons:
If you're the kind who gets nervous when you don't get your period, even if you've been diligently applying your birth control method, this method may stress you out. Bleeding suppression pills don't work for everyone -- some women still go ahead and have periods anyway. More common is some spotting, which won't be predictable. Finally, cutting against the research cited in "pros," is different research that questions the long-term effects of cycle-suppressing contraception. This method does not protect against STIs.

W
hat you should know:Your doctor should warn you of the possibility that you may not skip your periods 100 percent of the time; continuous birth control affects women differently. We still don't have studies for this conducted on women under 18, even though some doctors may prescribe it to teens. And current studies have only analyzed a test period of two years, so we don't yet have a good idea of what long-term effects of continuous birth control use will be.

7. Intrauterine devices (IUDs)

What if you never, ever had to think about birth control -- until the day you either decide to get pregnant, hit menopause or give up on contraception? Then an IUD is for you.

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How they work:
An IUD -- a tiny T-shaped device -- is inserted into your uterus by your health-care provider (it's not something you can do yourself). There are two popular kinds of IUDs -- one is hormonal and the other is made of copper, which acts as a natural spermicide.

Pros:
One of the most -- if not the most -- effective birth control methods out there, mostly because there is little room for error on your part. Once it's in, it's in and you don't have to think about it. Neither you nor your partner will ever feel it. You can keep it in for many, many years -- up to and beyond 10 years, if you pick the copper version. The day you want it out, just schedule an appointment to have it removed. If hormonal birth control hasn't worked for you in the past, the copper IUD could be your ticket out of hormone-land. But the hormonal IUD can decrease your period.

Cons:
Insertion is a minor but still surgical procedure. (You can ask for a local anesthetic.) While in the long-term an IUD is likely one of the cheapest birth control methods out there, the one-time up-front cost can be daunting (up to $600), particularly because most insurance plans don't cover it. With the copper IUD, most women get heavier and/or longer periods and report increased discharge and cramping. With the hormonal IUD, your period may become so irregular it can make some women nervous. Women who have a history of STIs or vaginal infections should avoid IUDs. And of course, IUDs do not protect against STIs.

W
hat you should know:Your doctor is likely to say that if you've never been pregnant and given birth you should avoid an IUD, because it could lead to infertility, but there is no data to back this up. Indeed, it's more likely doctors may be misremembering and speaking of an IUD from the 1970s -- the Dalkon Shield -- that killed women and doesn't resemble today's IUDs in any way other than they were both inserted in the uterus. Doctors may also say you should only use an IUD if you're married or longtime monogamous, since they're trying to account for the risk of STIs -- although this doesn't consider the fact that many single people have a lot of safe sex and a lot of married folks don't.

8. The Implant

The contraceptive implant has a bad name in the United States because a now-discontinued version drew lots of complaints from its users. But the new version of the implant has been popular throughout the world since 1998, and now it's making a splash among many American women.

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How it works:
Your health-care provider inserts a tiny, soft plastic rod in the layer of fat under the skin of your non-dominant arm. Good for three years, the Implant emits low doses of the hormone progestin, which prevents pregnancy.

Pros:
Like many of the other birth control methods that require little-to-no thinking on the user's part, after insertion you don't have to think about birth control for three years! This is a particularly good method for women who suffer heavy or painful periods, because the Implant may lighten your menstrual cycle.

Cons:
Irregular spotting or bleeding may occur -- for some women, this could be daily -- mostly because your period may become very light. Like other hormonal methods, your sex drive and vaginal lubrication may become affected. Epileptics, depressives and diabetics should avoid the Implant. Insertion and removal may be painful -- but doctors usually use lidocaine to numb your arm. This method does not protect against STIs.

What you should know:Not all doctors are trained to do this yet, so yours might not even offer it as an option. Your provider should also warn you that the implant is a lot more visible in the first weeks before it settles in -- this is normal.

9. Emergency contraceptives

As careful as you may be, no birth control method is 100 percent fail-safe. That's why it's a good thing we now have morning-after pills.

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How they work:
These over-the-counter pills are not to be confused with pills that induce a medical abortion. Emergency contraceptive pills cannot be used to end an existing pregnancy, but they can prevent one, especially if taken within 24 hours of intercourse (though it works for up to five days, less effectively each day). These pills usually work by preventing ovulation and/or making the vagina a less hospitable place for sperm.

Pros:
In the U.S., anyone 17 and over can get one of these pills without a prescription. The main thing the emergency contraceptive pill has going for it is that it's a fantastic second measure to take if a condom tore or you run into any other problems with your current birth control method.

Cons:
Emergency contraceptives have high progestin levels -- close to six days' worth of birth control pills taken over a two-day period -- which will likely cause an out-of-cycle period soon after taking one of these pills. Headaches and nausea are also likely. Emergency contraceptives cannot be used as a regular birth control method -- "emergency" is the keyword here. Of course, this method does not protect against STIs.

What you should know:A lot of people don't know you can buy emergency contraception for others -- men can even get it for their partners. Good to know is that you can get a prescription from your doctor in advance just in case -- because some pharmacies won't sell it without a prescription. (The ACLU is working to change this.) Also worth knowing is that you can actually use a copper IUD as an emergency contraceptive. The window of effectiveness there is increased to about eight days after intercourse. The added bonus is you not only prevent pregnancy in an emergency situation, you also have a long-term birth control method from there on out.

10. Tubal ligations & vasectomies

You may have noticed that many of the birth control methods discussed here are not appropriate for women over 35. Also, many of you might never want to become pregnant, so even a 10-year method like an IUD isn't good enough for you. For you we have tubal ligations and vasectomies!

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How they work:
Both surgical procedures, tubal ligation is a form of female sterilization in which the fallopian tubes are severed and sealed or pinched shut to prevent fertilization. And lest we forget that men have a role here too, vasectomies are the male version of tubals. In a vasectomy, a man's "tubes" -- or vas deferens -- are similarly severed and sealed to prevent sperm from entering the ejaculate.

Pros:
Vasectomies are far less invasive and expensive than tubals. Both are great options for people who've already had kids and don't want any more, or those who are sure they don't want children, ever.

Cons:
Both vasectomies and tubals should be considered irreversible, though some chances of reversal are possible.

What you should know: Many doctors will say this is a non-option for younger people or those who haven't yet had children, in the belief they may change their minds down the line and want kids after all. But if you've done all your research, don't give up. You'll find a doctor who understands that you're making an informed physical and emotional decision.

Daniela Perdomo is a staff writer and editor at AlterNet. Follow Daniela on Twitter. Write her at danielaalternet [at] gmail [dot] com.