Many of us go ages without giving our birth control a second thought. "But as you move through different phases, your needs may change," says Katharine O’Connell White, MD, assistant professor of obstetrics and gynecology at the Boston University School of Medicine. "What worked for you a decade ago may not be ideal now." The good news: There are more than a dozen options out there. Downside? It’s trickier than ever to choose. Use our guide to make an informed decision. From what’s the best emergency contraception to why IUDs are safer than people think, here’s the absolute latest on pregnancy prevention.
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You can use an IUD at any stage of life
IUDs are reversible, long-lasting (up to 10 years), and highly effective (more than 99 percent fail-safe)—which makes these devices a good option whether you’re in your 20s or your 40s, says Dr. White. Yet less than 7 percent of American women have an IUD. That may be due in part to an outdated misconception: In the past, IUDs were considered appropriate only for women who’d had kids, explains Dr. White. "There used to be a fear that IUDs would lead to infections, which could lead to infertility," she says.
But now doctors know that these devices don’t raise a woman’s risk of pelvic infection beyond the "insertion window," or the three weeks after the IUD is inserted. "So there should be no concern for women planning to have children in the future," says Dr. White. If you’re in a monogamous relationship—and you and your partner don’t have any STIs— “an IUD is very, very safe.”
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You still need birth control in your 40s
Yes, as you get older, it’s harder to get pregnant. But it’s still a very real possibility, cautions Colleen McNicholas, DO, assistant professor of obstetrics and gynecology at the Washington University School of Medicine in St. Louis. "I can’t tell you the number of times I’ve had a 40-something patient stare at me in shock when I’ve told her she’s pregnant," she says. McNicholas often recommends that women over 40 either take oral contraceptives, which can help relieve the symptoms of perimenopause, or use a hormonal IUD that can help regulate their period.
But bear in mind: These two forms of birth control may make it difficult to know when you’ve entered menopause. That’s because with the pill, you’ll still get an “artificial” period each month, and with the IUD, you may have no period at all.
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The pill can boost your health from head to toe
"Oral contraceptives offer a multitude of benefits beyond plain old birth control," says Shree Chanchani, MD, an ob-gyn at NYU Langone Medical Center. The pill may help fight off:
Acne: The pill lowers androgens, a group of male hormones that stimulate your skin to produce sebum (or oil) that clogs pores.
Ovarian cysts: If you’re not ovulating (thanks to the pill), it’s less likely these fluid-filled sacs will develop.
Facial hair: By regulating hormone levels, the pill can reduce hair growth on the chin and chest.
Fibrocystic breast changes: Also by tweaking hormones, the pill can reduce painful symptoms of fibrocystic breasts.
Menstrual cramps: Oral contraceptives thin the lining of the uterus, which leads to less menstrual bleeding and less intense uterine contractions.
Iron-deficiency anemia: Because it reduces blood loss during periods, the pill may help treat anemia.
Some cancers: Women on the pill reduce their risk of colon cancer by 14 percent and endometrial cancer by 43 percent, per a 2013 study. And taking the pill for five years lowers risk of ovarian cancer by 50 percent
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Don’t forget about condoms
This may seem obvious, but if you’re not in a monogamous, STI-free relationship, you need protection from more than unwanted pregnancy. STIs are always a risk—no matter how old you are. In fact, a study from Johns Hopkins University School of Medicine found that women in their 40s were more likely to have the parasitic infection trichomoniasis than 20-something women. Although older women overall tend to have partners who are less likely to be infected, it still pays to take the necessary precautions, says Dr. White. "I’ve unfortunately had to diagnose grandmothers with chlamydia. STIs weren’t even on their radar," she says.
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There might one day be a male pill
Researchers have been studying hormonal contraception for men for more than 40 years, but nothing has passed muster. Historically, the trial drugs blocked testosterone, which can have undesirable results. Recently, a clinical trial of a shot that did contain testosterone was canceled because of side effects such as depression—even though it was effective as birth control.
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Pill myths you should never believe
Oral contraceptives have been around for over half a century, but these misconceptions still remain.
1. The myth:It causes you to gain weight. A 2014 review found that taking the pill had no major effect on the scale. "I’ve had patients say they feel hungrier or more bloated," says Sherry Ross, MD, an ob-gyn in Santa Monica. "If they wait it out, it often gets better. If not, we can try another version."
2. The myth:It quashes your sex drive. In a study published in The Journal of Sexual Medicine, researchers found no difference in libido among women who were on the pill and women using other forms of hormonal contraception (like IUDs) and non-hormonal contraceptives.
3.The myth: You have to take it at the exact same time every day. With most pills, if you’re a few hours late, don’t sweat it. But progestin-only pills are different: The progestin doesn’t stay in your body for long, says Dr. White. If you’re three hours late, use a backup method for two days.
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What to know about emergency contraception
It doesn’t end pregnancy. The over-the-counter medication Plan B prevents pregnancy by temporarily stopping ovulation (provided you haven’t already ovulated). When taken within 72 hours after sex, it’s up to 89 percent effective.
It doesn’t work as well if you’re overweight. A 2011 study found that two types—Plan B and prescription-only Ella—are less than a third as effective if you’re obese. Ask your doctor about the copper IUD, which is effective whatever your weight.
A copper IUD is actually the most effective option. It can be inserted by a doctor up to five days after unprotected sex, and there’s less than a 1 percent chance of pregnancy.
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More permanent options
A look at the options for you and your partner.
Tubal Ligation. What it is: The fallopian tubes are sealed with electric current, by tying and cutting, or with clamps, clips, or rings. Cost: Up to $6,000. Pros: It’s effective immediately. Cons: There’s a complication rate of up to 4 percent, according to Planned Parenthood. You have to wait about two weeks to resume normal activity, says Dr. White.
Vasectomy. What it is: A procedure that blocks or cuts the tubes in the scrotum that carry sperm. Cost: Up to $1,000. Pros: It’s cheaper than tubal ligation and has few complications, says Dr. White. Most men go back to work within two days and resume regular activities after a week. Cons: You still need backup birth control for about three months.
Essure. What it is: An ob-gyn places "microinserts" in the fallopian tubes, causing tissue to grow and seal them off. Cost: Up to $6,000. Pros: It can be done under local anesthesia. Cons: One study published in 2015 in BMJ found that women with Essure were 10 times as likely to have additional surgery within a year compared with women who got their tubes tied. (The manufacturer disputes the study’s findings.) While some patients have reported complications, including perforation of the uterus or pain, the FDA says Essure remains an appropriate option for the majority of women.