What are the available birth control options, including their pros and cons, for a patient presenting for an initial birth control consultation?

From the Guidelines

For a patient seeking birth control, the most effective options with the fewest side effects are Long-acting reversible contraceptives (LARCs), including hormonal IUDs and the implant, which have over 99% effectiveness and are safe for most women 1. When considering birth control options, it's essential to evaluate the patient's medical history, including menstrual history, pregnancy intentions, and any chronic diseases, to determine the safest and most suitable method 1. The available options include:

• Hormonal methods: combined oral contraceptives (COCs), progestin-only pills, the patch, and the vaginal ring, which offer benefits like reduced menstrual pain and acne but may cause side effects such as nausea and headaches.
• Long-acting reversible contraceptives (LARCs): hormonal IUDs (Mirena, Kyleena, Skyla) and the non-hormonal copper IUD (Paragard), which are highly effective and often have lighter periods.
• The implant (Nexplanon), which is inserted in the arm and lasts 3-5 years, with over 99% effectiveness.
• Depo-Provera injections, given every 3 months, with 94% effectiveness but may cause weight gain and delayed fertility return.
• Barrier methods: male condoms, female condoms, diaphragms with spermicide, and cervical caps, which have varying effectiveness and require consistent use.
• Emergency contraception options: Plan B and ella, which can be used within a limited time frame after unprotected sex.
• Fertility awareness methods, which require careful tracking and abstinence during fertile periods.
• Sterilization, which provides permanent contraception. The choice of birth control method depends on the patient's health history, preferences, desire for future pregnancy, and lifestyle factors, and should be personalized to ensure the best outcome 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Contraceptive Options

• Oral contraceptive pills: the most commonly used reversible method of contraception, comprising 21.9% of all contraception in current use 2
• Long-acting methods: such as intrauterine devices and subdermal implants, with failure rates of less than 1% per year 2
• Estrogen-containing methods: such as combined oral contraceptive pills, which increase the risk of venous thrombosis 2
• Progestin-only methods: such as implants, which are associated with rare serious risks 2
• Nonhormonal methods: such as condoms, which are associated with rare serious risks 2

Pros and Cons of Contraceptive Options

• Oral contraceptive pills:
  • Pros: improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 2
  • Cons: pregnancy rates of 4% to 7% per year, increase the risk of venous thrombosis 2
• Long-acting methods:
  • Pros: high effectiveness, with failure rates of less than 1% per year 2
  • Cons: may have higher upfront costs, insertion and removal procedures may be required 2
• Estrogen-containing methods:
  • Pros: improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 2
  • Cons: increase the risk of venous thrombosis, may not be suitable for women with certain medical conditions 2
• Progestin-only methods:
  • Pros: associated with rare serious risks, may be suitable for women who cannot use estrogen-containing methods 2
  • Cons: may have lower effectiveness compared to long-acting methods, may cause changes in menstrual bleeding patterns 2
• Nonhormonal methods:
  • Pros: associated with rare serious risks, may be suitable for women who cannot use hormonal methods 2
  • Cons: may have lower effectiveness compared to hormonal methods, may require more frequent use 2

Initiating Contraception

• Most patients can safely begin using hormonal contraception at any point in their menstrual cycle 3
• A recent Papanicolaou test is not necessary before prescribing hormonal contraception 3
• Patients can begin using progestin-only contraceptives immediately after childbirth, and any appropriate contraceptive method immediately after an abortion or early pregnancy loss, except for an intrauterine device following septic abortion 3
• Clinicians can facilitate the use of hormonal contraception by providing anticipatory guidance about common side effects, giving comprehensive information about available contraceptive choices, honoring patients' preferences, and eliminating office-related barriers 3

Special Considerations

• A new oral contraceptive containing drospirenone and ethinyl estradiol plus levomefolate calcium was formulated to decrease the risk of neural tube defects in pregnancies conceived while taking or shortly after discontinuing this pill, although no study has been performed to evaluate the effect this new oral contraceptive has on reducing the incidence of neural tube defects 4
• Physician time is better spent counseling women, regardless of contraceptive choice, on the importance of folic acid supplementation during the child-bearing years 4