Contraceptives Come with Side Effects

I’m back in school studying for my Doctorate of Nursing Practice—yes, it’s true, nurses can go all the way to the doctoral level! As a part of that degree I’m devising and implementing a project based on valid evidence or research. My project focuses on contraceptive education. Here’s why.

The rate of unintended pregnancy in this country still hovers at nearly 50 percent (and only 5 percent of those are because of true contraceptive failures—the other 45 percent are due to misuse or disuse of contraception). So, critical to my project is looking at what factors encourage women to be compliant, or not, with their birth control. One of the key factors is a woman’s understanding, expecting, and managing normal side effects of her chosen method. Let’s review the most common methods and their most common side effects (particularly the ones my patients notice). 

Common contraception methods and their side effects (from most effective to least effective)

  • Implanon/Nexplanon (contraceptive rod inserted under the skin of the upper arm for 3 years) – irregular unpredictable vaginal bleeding that may of may not improve over time
  • Essure (coils placed in the tubes to block the tubes) – permanent, takes 3 months to work, must have an imaging study to verify that the tubes are blocked, cannot be reversed
  • Mirena IUD (hormone laden device placed in the uterus for 5 years) – irregular bleeding usually in the first 3-6 months, may result in lack of periods or very light periods after that
  • Laparoscopic Tubal Ligation (blocking of the tubes from inside the abdomen) – permanent, works immediately, requires surgery, may fail as time progresses if the tubes grow back together, can be sometimes reversed through an expensive delicate procedure by a highly trained doctor
  • Paragard IUD (copper wrapped device placed in the uterus for 10 years) – results in normal monthly menses but they may be slightly heavier or crampier
  • Depo Provera (hormone injection given every 12 weeks) – may lead to irregular unpredictable vaginal bleeding or no periods, results in bone loss – will need a calcium supplement, increases hunger with a 5 lb/year weight gain expected, some complain of hair loss
  • Combined Oral Contraceptives (birth control pills with both estrogen and progesterone taken daily) – controls and decreases menstrual bleeding, raises the risk for blood clots in the vessels that can cause strokes/heart attacks/pulmonary embolism, any missed pills can result in vaginal bleeding and lack of contraceptive coverage
  • The Patch (skin patch with both estrogen and progesterone, reapplied weekly for 3 weeks) - controls and decreases menstrual bleeding, raises the risk for blood clots in the vessels that can cause strokes/heart attacks/pulmonary embolism, some will be sensitive to the adhesive or the material the patch is made of
  • Nuva Ring (vaginal ring with both estrogen and progesterone that is inserted for 3 weeks) - controls and decreases menstrual bleeding, raises the risk for blood clots in the vessels that can cause strokes/heart attacks/pulmonary embolism, some complain of increased vaginal discharge
  • Progesterone Only Pill (“mini-pill”, a daily pill taken with only progesterone) – may cause some irregular bleeding, MUST be taken exactly at the same time daily or contraceptive coverage is lost
  • Condoms (male or female) – must be placed properly prior to sex and be left in place until sex is completed, most are made of latex, best defense against sexually transmitted diseases and should be used in conjunction with other methods for this purpose
  • Diaphragm/Cervical Cap (devices placed in the vagina as barriers) – made of latex, must be used with spermicide which can be irritating to the vaginal tissue, must be placed prior to sex and left in place until sex is completed
  • Spermicide (gel/foam/suppository/film inserted in the vagina to kill sperm – should be used with a barrier method) – can be irritating to the vaginal tissue 

When you’re choosing, think about the side effects

So when it comes time to choose a contraceptive method, it is important to consider the side effects. Talk to your healthcare provider about the options available to you, the side effects you can expect, and how you plan to deal with them. If you are aware of the side effects and prepared for them, you will be more likely to continue the method and decrease your risk of unintended pregnancy.

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