Uses, risks and benefits of non-pill options

You don’t need to take a pill every day. There are birth control methods that last for weeks, months, or even years with little effort—and no surgery. They are safe and effective for most healthy women.

Which one is best for you?

“The best birth control method for any woman is the method that she uses correctly and consistently,” says Elizabeth Micks, MD, MPH, assistant professor of obstetrics and gynecology at the University of Washington Medical Center.

Find out what’s available, what it’s all about, and how well they all work.

The IUD

This is a small, T-shaped device that your doctor places in your uterus after the examination. Depending on its type, it can last there for 3-10 years.

Once the IUD is in place, there is nothing else you need to do to avoid pregnancy. They are 20 times more effective than pills, patches or rings. Less than 1 in 100 women will get pregnant in the first year of using an IUD.

Your doctor can easily remove it if you decide you want to get pregnant or if you no longer want to use it.

Hormonal IUDs they are plastic and release the hormone progestin. This thickens the lining of the cervix (the lower part of the uterus), which prevents sperm from entering. It also thins the uterine wall. This prevents the fertilized egg from attaching, which is part of pregnancy.

Four brands of hormonal IUDs are available: Kyleena, Liletta, Mirena, and Skyla. They all rely on the same drug, levonorgestrel. Liletta and Mirena have been living together for 6 years. Kyleena releases the lowest dose of hormone for the longest time. It lasts for 5 years. Mirena can reduce heavy menstrual bleeding by up to 90% after the first 6 months.

“It is so effective in treating women with heavy bleeding, painful periods, even women with endometriosis [a disorder of the uterus]myoma [noncancerous tumors]and other issues,” says Micks.

Some women have the disadvantage of surviving the first 6 months. “Hormonal IUDs can cause a lot of irregular bleeding initially, which is really not acceptable for many women,” says Micks. “Women do not like spotting (light bleeding between periods).

Copper IUDs they are hormone-free. Copper acts as a spermicide and prevents the sperm from fertilizing the egg. If an egg is fertilized, it can prevent the embryo from implanting.

Women who want hormone-free birth control (meaning fewer potential side effects) often choose these devices. However, hormone-free contraception does not have the same effect on the menstrual cycle.

“It’s not true for all women, but in general, periods can be a little heavier and crampier with a copper IUD,” says Micks. “We wouldn’t choose this method for women who already have heavy periods.”

Contraceptive implant

Your doctor will insert this small, thin and flexible plastic rod into your arm. The size of a matchstick. Like the hormonal IUD, the implant releases progestin into the body. It works for up to 3 years and can be removed by your doctor at any time before that.

Like the IUD, implants are 20 times more effective than pills, patches or rings.

Some women experience irregular bleeding during the first 6-12 months. In most cases, periods become lighter and less frequent.

“The thing about an implant is that it’s very unpredictable,” says Micks. “Some will stop having their period, but some will have a little more bleeding.”

Micks says of her patients, “If they don’t want to get pregnant within a year, I recommend getting an IUD or an implant,” she says. “They can take it out anytime, whether it’s a day later, a month later, whenever.”

A study in Finland found that providing free long-acting reversible contraception (LARC), such as IUDs or implants, resulted in more LARC use and fewer abortions in the community.

The shot (Depo-Provera)

This method protects against pregnancy for 3 months at a time. It uses progestin for this.

Only 1 in 100 women who receive the vaccine every 12 weeks can get pregnant. For those who don’t get the vaccine on schedule, 6 out of 100 will get pregnant.

As with other progestin methods, the shot may cause irregular bleeding in the first year. About half of women will have fewer and lighter periods afterward. Others may experience spotting or more severe, longer periods.

The shot can cause osteoporosis, which stops after the injection. For this reason, women at risk of osteoporosis must use a different form of contraception.

If you want to use the injection for more than 2 years, discuss the risks and benefits of continuing treatment with your doctor. Women with breast cancer and those taking certain medications for Cushing’s syndrome (a disease caused by exposure to high levels of the hormone cortisol) should also not receive it.

Some women may not want the vaccine because it requires going to the doctor’s office every 3 months. In some parts of the United States, women can get a prescription for an injection that they give themselves. If you’re worried about getting an injection, find out if there’s a good place to get it – like a local health center – before you decide.

If you want to get pregnant within the next year, consider other birth control methods. After stopping the injection, it may take 10 or more months for you to become fertile again.

Combined birth control

Like most birth control pills, the patch and ring prevent pregnancy with the hormones progestin and estrogen. Use the patch and ring for 3 weeks, then stop for 1 week. During this “break” you will have your period. Some women who want to stop their period completely can’t take a week off.

Women who take the fourth week off often have lighter periods with fewer symptoms.

You need to replace the patch or ring in time. Nine out of 100 women who do not use them as directed will become pregnant.

Like the pill, the patch and ring can increase the risk of blood clots. It is not recommended for women with risk factors for stroke, blood clots or heart disease, such as women over 35 who smoke.

The patch a thin, beige, plastic sticker that you can always wear on your skin for a week. Stick it on the outer side of the upper arm, the back, the back or the stomach. You change the patch weekly for 3 weeks, then usually take a week off.

Some women complain that the patch falls off or irritates the skin where it was applied.

The circle another possibility. Sold as Annovera or NuvaRing, it’s a small ring that you insert into your vagina, similar to a tampon. You leave it in for 3 weeks. After that, you take a week off to experience your period. With Annovera, you can then put the ring back on. With NuvaRing, you insert a new ring.

The ring may fall out before it is time to replace it. If this happens, simply rinse it and put it back. If it is broken, insert a new one.

The patch and ring are not as effective as pills, IUDs, implants, or injections. But some women still use the patch and ring, Micks says, because they feel more in control of the method, which they can stop at any time without seeing a doctor.