By Rachel Flink, MD
While the point of birth control seems simple, people’s goals for birth control can be varied. It’s important to understand your own goals to help you choose the method that most closely aligns. Some people never want to have children, while others merely want to delay it for a while. Some people really, really don’t want to get pregnant until they’re ready, while others are more open to the possibility of a pregnancy along the way. Some people don’t want to have to think about their birth control (“set it and forget it”), while others want to have a more active role in the process and don’t mind the inconvenience of medication doses or periodic abstinence. Each person must also weigh the inconvenience of side effects against effectiveness and convenience of use.
However, after all of the talk about preferences, goals, side effects and other concerns, your doctor is likely to recommend the easiest, most effective and safest methods. It’s like telling your travel agent you want to cross the country – despite all the modes of transportation available, she’ll assume you want to take an airplane, and she’ll hop on the computer to book you a flight. When all is said and done, most people want to get where they’re going in the most efficient way. For instance, some people don’t love the idea of flying, worrying about giving up control, not being able to get off the plane at the exact moment they want, potential delays or lost luggage. However, these people still often choose to fly because they have other priorities (convenience, travel time, cost-effectiveness, prior experiences) that are more important than the annoyances of air travel.
When it comes to choosing a birth control method, people have similar fears – of discomfort, of side effects, of not liking their method and having to wait for an appointment with their doctor to come up with a different plan. It’s important to weigh these fears against your priorities, such as how much you want to prevent pregnancy, whether you want to avoid frequent trips to the pharmacy or remembering to bring medications with you, whether you’re willing to give up some spontaneity in your sex life. For many women, after discussing priorities with their doctor, they find themselves hearing about long-acting reversible contraception, or LARC, including IUDs and implants. In addition to all the aforementioned reasons to recommend an IUD, here’s another endorsement: it’s the same thing most of doctors choose for themselves.
Multiple studies have shown that female physicians use long-acting reversible contraceptives (LARC), including IUDs and implants, at a higher rate than the general population. A study published in 2015 specifically surveyed family planning providers, meaning the doctors and other clinicians who are experts on birth control, and found that IUDs are the most popular form of the birth control chosen. Almost 40% of female family planning providers use an IUD, and almost 2% use a contraceptive implant (Implanon/Nexplanon), ratios which are 2-3x higher than use of those methods in the general population. Even after accounting for the fact that many family planning providers seem to use LARC in place of sterilization, higher LARC use persists in those who have not completed childbearing. Most notably, 35% of providers who are not done childbearing, and 54% of those who are unsure, are using LARC methods, compared with the general population, where only 16% of women who are not done childbearing and 3% of those who are unsure are using LARC methods. The vast majority of LARC users are using an IUD, and the majority of those users have the Mirena hormonal IUD.
So what does all this mean?
You and your doctor or other clinician should work together to choose a method of birth control. Your doctor can use her medical knowledge to try to align with your reproductive goals, and you should absolutely ask questions and try to get all the information you need to make your best decision. Ultimately, only you can know your ideal balance between effectiveness, convenience, side effects and risks when it comes to choosing a birth control method, based on your needs and desires. But if you’re looking for an effective, easy-to-use, safe method with few side effects, don’t be surprised if your doctor recommends an IUD – after all, she is trying to give you the same care she would choose for herself!
Rachel Flink, MD is an OB/GYN currently practicing in Western Pennsylvania and obtaining her Masters in Public Health at the University of Pittsburgh. Her clinical interests include reproductive health, pregnancy care, family planning, and minimizing barriers to care. Rachel’s research is focused on understanding women’s experiences with and preferences for reproductive health care. Outside of work, she enjoys reading, being active outdoors, and spending time with her husband, two-year-old son, and rambunctious dog.