This guest blog was written by Sophia Yen MD MPH, CEO, Co-Founder of Pandia Health, the ONLY Doctor-Led, Women-Founded and Women-Led birth control delivery company. Board certified in Adolescent Medicine. Dr. Yen is a Clinical Associate Professor of Adolescent Medicine at Stanford Medical School (for identification purposes only)
For yourself and for your students, it’s important to know all the birth control options. Here are most of the birth control options from most effective to least effective. I think you’ll be surprised that some of the reversible options beat the irreversible ones!
Most Effective to Least Effective
*Abstinence has 100% efficacy if practiced perfectly, but of those that take virginity pledges, 30% got pregnant while not married vs. ~18% of those who did NOT take pledge got pregnant while not married. (The Atlantic: The Unintended Consequences of Purity Pledges by Olga Khazan)
Here’s the CDC diagram that I like though the latest research shows that the IUDs and tibal ligation don’t work as well in typical use as perfect use (what’s listed on the diagram for IUDs, tubal ligation).
Typical pregnancy rates in recent US study by Schwarz et al 2022 for:
Hormonal IUD 2.4%
Laparoscopic Tubal Ligation 2.64%
Copper IUD 2.99%
Some quick notes on the various methods:
Implant: the procedure for putting it in is pretty easy. I bet my 12 year old could do it. You measure 8-10 cm from the medial epicondyle process. Numb up the area. Insert the implant. Slap on a pressure dressing.
Biggest side effect: irregular bleeding. Should get better after 3 months, if not, then most likely will continue to be irregular.
Pro: For the implant and IUD with hormone, 30% will lose their monthly bleeds. Yay! And the remaining 70% have lighter, shorter bleeds.
IUD: tips for when you get it placed.
- Go on the last days of your period. So your uterus is empty but the cervix is open. But also ok to go on other days.
- Take 600 mg ibuprofen 30min to 1 hr before WITH food. That will help decrease pain.
- Ask for a cervical block (numb up the cervix area).
Copper IUD: top 2 side effects: more blood, more cramps. If you are the person who doesn’t notice your bleeds or periods, this may be great for you. If you bleed like stink with your periods or feel every menstrual cramp, perhaps not.
Shot (Depot Provera): major side effects:
1. gives you the munchies. So if you are overweight, you may gain weight.
2. Not good for your bone density. But the bone density goes back to normal after being off for 3 years. And not getting pregnant is better than being pregnant’s side effect on your bones. Make sure you get 1200 mg of calcium a day and Vitamin D while on this method.
Ring, Patch, Pill: Pro: you can use them to make #PeriodsOptional. Just skip the placebo/week off. See this blog for more information: https://www.pandiahealth.com/period-optional/
Negative: $$$ and only 20 mcg of estrogen. As Adolescent Medicine specialists, we usually recommend at least 30 mcg of estrogen in birth control pills for your bone density, until you are 30 years old. But any birth control method is better than being pregnant with respect to effects on your bone density. You have to be comfortable inserting it and taking it out.
Positive: you only have to think about this once a month.
Patch: Comes in 2 types:
Xulane (Norelgestromin with ethinyl estradiol) (generic of Ortho-Evra patch which was discontinued) 14 cm2
Con: in the blood, noted to have high levels of estrogen compared to pills.
Twirla (Levonorgestrel with ethinyl estradiol) 28 cm2
Pro: purposely formulated to have the same dose of estrogen like a 30 mcg estrogen containing birth control pill.
Con of both: expensive. However, under the Affordable Care Act (Thanks former President Obama and current President Biden) any FDA approved birth control should be covered by insurance with NO copay, no deductible = free! The only exceptions are religious employers e.g. Jesuit Colleges, Hobby Lobby, etc.
Con: you have to remember to take it at the same time every day
Pro: there are 40 different types of pills, so if 1 doesn’t work, you have 39 other options. There are 8 different progesterones, so please NOTE the exact formulation that you like or don’t like and tell your doctor so they can prescribe accordingly.
Condoms: know that there are different thicknesses and different sizes.
Most condoms can fit over a watermelon. However, if you are noticing that the condom slips off while erect or there’s the “red ring of death” at the base after sex, then check out One Condom which has 60 sizes.
Pro tip: Thinner = better sensation = probably better adherence. I like condomdepot.com where they rate condoms by person with vagina versus person with penis. At the Stanford Teen Clinic we pride ourselves in having the condoms with the best sensation.
Benefits: is the only method that protects against Sexually Transmitted Infections aside from abstinence, masturbation.
Con: You have to use it each time you have sex and be confident enough to ask your partner to use it each time or have the restraint to put it on before sex each time. “No Glove, No Love!” “No Globos, No Fiesta!”
FAM – Fertility Awareness Method: Fertility Awareness Methods require great restraint (don’t have sex on certain days) and have a high typical use failure rate ranging from 8-23% for most options. pro: no hormones. con: high failure rate and need good self control and lots of tracking. Combining FAM and condoms would be better.
- The Atlantic: The Unintended Consequences of Purity Pledges by Olga Khazan
Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation. Schwarz, EB et al, J Gen Internal Med 2022