Birth Control: Your Options & What You Should Know

This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about birth control options and what you should know. Our guest is certified nurse midwife Corry Varner, who's been a nurse midwife for more than a decade and has earned a doctorate in nursing practice. MemorialCare Medical Group recently welcomed a group of OBGYN physicians and midwives, including Corry, to their Fountain Valley office, and we're thrilled to have her on our show today. Welcome, Corry.

Corry Varner, DNP: Thank you for having me.

Deborah Howell (Host): It's our pleasure. People have used birth control methods for thousands of years. Today, women have so many safe and effective birth control options, but convenience, safety, advocacy, affordability and spontaneity vary with each method, of course. So I got to ask you, what's the best method of birth control?

Corry Varner, DNP: Well, that really depends on you as a woman. There really isn't a certain type of birth control that's best for everyone. Normally what I like to do is when a woman comes in, we discuss several factors that play into that decision. A couple of them are how soon she's looking to get pregnant, how well each method is going to work, the possible side effects, the number of current sexual partners she has, her overall health, if she's a smoker. And the number one thing is if she's going to be comfortable using the method because if she's not comfortable, she's not going to do it.

Deborah Howell (Host): Right, right. Okay, well, that's good to know. Now, let's talk about some of the different types of birth control.

Corry Varner, DNP: Okay. Well, there are quite a few different types of birth control. They're broken down into five main categories. The first one are female-male sterilization. These are permanent, and they do require a medical procedure, but they are over 99% effective. The second type that we deal with are the long-acting reversible contraceptives. These are ones where you come into your provider's office, and we would place the device. And then after that you don't have to think about it for anywhere from 3 to 10 years depending on the type you choose. They're also 99% effective. These include your different IUDs such as Laileta, Mirena, Skyla, Paragard, and then also the implant Nexplanon. The other methods that we have, which are the ones that women are probably most familiar with, are the short-acting hormonal methods. These are the pill, the patch, the shot, the NuvaRing. These require a woman to either take them every day or every week, every month. With the shot, you can get away with doing a shot in the office every three months. The part on this that you play with is what you look at where it's perfect use versus typical use. And in these methods, the reality is most of the time women aren't going to be perfect in the way that they should be done. So you normally have an effective rate of about 91% on that. So about 9% of women will get pregnant on that.

Deborah Howell (Host): Okay.

Corry Varner, DNP: The fourth one is the barrier method. Now, these are normally the ones that you don't need a prescription for. You can buy at the store. There are the condoms, the diaphragms, spermicides. These are ones that you want to make sure they're using with every sexual encounter you have. Now, because of the fact that they don't always get used, they are not as effective. Some of them as low as 72%. And then the final one that we fall into is the natural rhythm method. This is one most women are not familiar with. It's pretty much avoiding intercourse or using birth control only when you are at your most fertile time, which is when you're likely to get pregnant. This one can be quite difficult if you're not monitoring your body regularly and if you don't have a regular period and it's only 76% effective against pregnancy.

Deborah Howell (Host): Okay. Which of these types of birth control help prevent sexually transmitted infections?

Corry Varner, DNP: The only ones that are actually going to help prevent sexually transmitted infections are both the male and female condom. Now, the problem that you're going to run into that is, like I said, they're not as effective as your other forms of birth control, where you're only looking at about 82% effectiveness with the male condom, which is the most common type of condom.

Deborah Howell (Host): Just 82%?

Corry Varner, DNP: Only 82%.

Deborah Howell (Host): Wow.

Corry Varner, DNP: Normally, what we will recommend for women is that they will use some other form of birth control along with the condom so that they are protecting themselves. It's called dual protection.

Deborah Howell (Host): Got it. Wow, I hadn't realized that. Okay, that's quite a statistic. All right. Which types of birth control, Corry, can I get without a prescription, and which do I need to see my provider for?

Corry Varner, DNP: Okay, so the ones that you don't need to come in and see me for are normally the barrier birth controls that we talked about, the male and female condoms, the sponges, the spermicides. But you can also get the emergency contraceptive or the Plan B pill over the counter. That does not require a prescription. But what's important for women to realize is that you don't want to be using that as your normal form of birth control because it doesn't work as well, and it's only to be used in case of emergencies, and it is not an abortive agent. So if you're already pregnant, it's not going to stop the pregnancy. Now, for ones that you would need to come in and see me for are going to be the ones that require a prescription as far as the patch, the pill, the NuvaRing, and then obviously if you needed to, wanted an IUD or a Nexenol place, we would do those. And then, of course, we would need to do a referral for if you wanted something permanent as far as a sterilization.

Deborah Howell (Host): Okay, got it. How effective is the withdrawal method?

Corry Varner, DNP: Okay, it's actually not that effective. Most people will know the withdrawal method as the pulling out method, where a man withdraws his penis before he actually ejaculates. But what we find is that semen, which is the fluid that can be released before a man even, does ejaculate, can have sperm as well. So it actually is only 78% effective.

Deborah Howell (Host): Okay. Okay. Women should definitely know that, especially young women who get told that, don't worry, right?

Corry Varner, DNP: Yes, exactly. And I mean, the reality is, when you're in the moment, it does take a lot of self-control to be able to withdraw during that time. And then if you think about it, okay, now we still have a 22% chance of pregnancy.

Deborah Howell (Host): Yeah, yeah. That's not a mentally good thing for a young woman or a young man for that matter. Does breastfeeding prevent pregnancy, Corry?

Corry Varner, DNP: It actually can, but there are three key factors that you have to play into for that. The baby needs to be less than six months old. You need to be exclusively breastfeeding. So that means no supplementing, no formula, no solid foods, and you need to be breastfeeding every three hours. And then you can't have already started your period. Once you start your period, your body is ovulating. So that is a sign that you can get pregnant. So all three of those need to come into play. If any three of those are not, then you definitely have a risk for pregnancy.

Deborah Howell (Host): Wow. So if you go four or five hours instead of three hours, that could be the difference.

Corry Varner, DNP: It could. But if you are following all three, it's about a 98% effectiveness against pregnancy. But that's why you need to make sure you're staying on top of all three of those.

Deborah Howell (Host): Sure. Okay. And tell us a little bit more about the IUD. People are always wondering, will it hurt? Will I feel it constantly in my system?

Corry Varner, DNP: Well, there are actually four IUDs that we have now. There are three that have hormones and one that doesn't. The Paragard is the only one that does not have hormones. It's good for up to 10 years, but you can have more bleeding and cramping when you're on your period with it than with the other methods. The Lylata, the Mirena, the Skyla all have a little bit of progesterone, but they decrease bleeding, decrease cramping. Now, once the device is placed, it normally takes about 24 hours to settle, and you may get some cramping during that time. But after that, most of the time, you do not feel it. Your partner should not feel it during intercourse, and you pretty much go around your life and not have to worry about any kind of birth control for 3 to 10 years.

Deborah Howell (Host): And you found that your patients have been happy with that?

Corry Varner, DNP: I find that that is one of the major ones that I do place, and that most women are very happy with it. Another device that my patients are happy with is also the Nexplanon. It looks like a little matchstick that we place into the arm, and that's also good for three years. Some women, the part that they don't like about the IUD is they don't like the idea of something being in the uterus.

Deborah Howell (Host): Yes.

Corry Varner, DNP: Some women are completely fine with it. Some women, they are a little timid about that. So the next one on would work for that, especially in your younger women if they've never had a child or they're their later teens. The one in the arm, it can be a better choice for them.

Deborah Howell (Host): What else should we know? About today's, you know, different methods of birth control?

Corry Varner, DNP: You should never be afraid of birth control. There's so many different possibilities out there, and if you're not sure what's working for you, it's important, you know, make an appointment with your provider and come in and just have a consult to talk about the different methods and talk about your history and what's going to be good for you because there is something that is going to work for every woman. We just have to find out what it is.

Deborah Howell (Host): Exactly. Well, thank you for that. And thank you so much, Corry, for your time and expertise today.

Corry Varner, DNP: Well, thank you for having me.

Deborah Howell (Host): We really enjoyed having you on the show. And for more info or to listen to a podcast of this show, please visit memorialcare.org/OBGYN. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.