I’m Done Having Babies: Exploring Long-Term and Permanent Birth Control Options

Anne Brown, MD, is board certified in obstetrics and gynecology. She is currently the medical director of the Women’s Health Service Line for Inova Loudoun Hospital. Read Dr. Brown’s Profile.

Maybe you’ve decided you don’t want to have children. Maybe you’ve had babies but are certain (or pretty certain) your family is complete. What’s next? Luckily, you have a variety of safe and effective long-term birth control options to choose from.

Hormonal Contraceptives

Hormonal contraceptives include oral contraceptives (birth control pills), the OrthoEvra patch and the NuvaRing. Today’s versions use very low doses of hormones. They are familiar and popular options that are typically safe to use right up until menopause. However, hormonal options aren’t a good choice for smokers over age 35 or for women with significant risk factors for early-onset breast cancer or blood clots.

IUDs

Intrauterine devices, commonly called IUDs, are placed through the cervix into the uterus to stop sperm from fertilizing eggs. My colleagues and I place IUDs in a simple office procedure. IUDs typically require pre-authorization from your insurance company.

Several IUD options are available:

• The ParaGard is copper-based and provides protection against pregnancy for 10 years. Some women experience heavier periods as a side effect.
• The three other IUDs on the market release low doses of progesterone into the uterus: Mirena lasts 5 years, while Skyla and Liletta are currently approved for 3 years. Progesterone-based IUDs typically cause periods to be lighter.

Because the progesterone-based devices act locally, any of these IUDs are good options for women who can’t tolerate or don’t like to use hormonal contraceptives, such as the pill. And if you decide you’d like to get pregnant after all, the IUD can be removed.

 Sterilization Options

Some of my patients prefer more permanent surgical procedures to avoid pregnancy. These options include:

• Tubal ligation. This surgery is performed laparoscopically through a tiny incision. Sometimes, we do tubal ligations right after the birth of a child, while the patient is still in the hospital. Less than 1 percent of women become pregnant after tubal ligation. However, I caution my patients that in those rare cases, there’s an increased risk of ectopic pregnancy.
• Essure is a newer option for sterilization. It involves placing small spring-like devices into the fallopian tubes. We can do this without making an incision and can often perform the procedure in an office setting. Over the next few months, scar tissue grows around the devices, blocking the release of eggs from the fallopian tubes. Just to be sure, patients come in for an X-ray study three months after the surgery to make sure the fallopian tubes are completely closed.

To figure out which option is right for you, talk to your healthcare provider. It’s important to me to help each of my patients understand the benefits, side effects and possible risks to help them find their best option for taking control of their reproductive health.

To learn more about contraceptive choices, visit Capital Women’s Care (formerly Loudoun Physicians for Women) to make an appointment.