Many culture articles recently have noted that millennial women seem to be ditching the pill in favor of nonhormonal birth control options or other methods that don’t require such rigorous attention. But why are they making these changes and is it right for you?
Millennials’ Conflicted Feelings Toward Birth Control
In general, young women are in favor of birth control and many of them use it. More than 70 percent of millennials (men and women) think birth control is morally acceptable, and 60 percent think contraception is necessary for women’s financial security, according to recent research by the Public Religious Research Institute. At the same time, however, millennials are also interested in health and natural lifestyles, which leaves many of them conflicted about using hormonal contraception.
Many articles from Cosmopolitan to the New York Post have one similar conclusion: Younger women seem to be moving away from the pill. Dawn Anderson, MD, a gynecologist at Lahey Hospital & Medical Center, is finding similar trends with women in the Boston area at her practice.
Dr. Anderson said many women she sees are on some form of hormonal birth control – with many of them choosing intrauterine devices (IUDs) over systemic forms of birth control like the pill.
“In the past, about 90 percent of patients would opt for the pill, but now it’s about 50 percent opting for the pill and 50 percent getting an IUD,” she said.
Why the shift? Convenience and side effects are two reasons.
“Most importantly, an IUD offers an increased efficacy that other forms of birth control may not. With more women working and traveling and having complicated schedules, it’s nice not to be tied to a clock,” she said. “Some patients also feel they have more side effects from systemic hormonal birth control, like the pill, patch or ring. Generally, progesterone IUDs have fewer side effects.”
Choosing birth control is a highly personal decision and one that should be made with your provider. Everyone’s lifestyle, preferences and experiences with birth control are different. In addition to preventing pregnancy, women may opt for birth control to treat acne, heavy periods or painful cramps.
Women have more choices than ever and may not even realize what’s available to them. Here’s a quick overview:
Hormonal options tend to be the most effective at preventing pregnancy and treating other symptoms. But they do come with their own risks and side effects.
- Combination Estrogen/Progesterone. Including the pill, ring and patch, these forms use a combination of estrogen and progestin. There are also progesterone-only options available, including the pill and injection. When used perfectly, these methods are 99 percent effective, but, realistically speaking, they’re about 90 percent effective at preventing an unwanted pregnancy.
LARC, or long-acting reversible contraception, are birth control options for those who may not be able to stick to the strict schedule put in place by the pill.
- Implant. This is a small rod-like device implanted in your arm that slowly releases progesterone. You can leave it in for up to three years, and it’s 99 percent effective.
- IUD. In the past few years, the IUD has come a long way, with smaller devices that deliver even lower doses of progesterone. You will likely still have a period with new, lower-dose versions. These can be left in for three to five years.
- Progesterone IUD. A lot of younger women are opting for this hormonal option. It may also help with heavy menstrual bleeding and, potentially, other hormonal concerns.
- Copper IUD. These deliver no hormones, but many women experience more cramping and heavier periods.
Barrier methods tend to be about 70 to 80 percent effective, according to the American College of Obstetricians and Gynecologists.
- Condoms. When used correctly and without failures, condoms are a highly effective form of birth control. Realistically, the American Academy of Family Physicians puts these at about 82 percent effective.
- Sponge. This is a small, thick sponge (hence the name) that is placed in your vagina. It then blocks sperm from getting to your cervix and uterus. It doesn’t help with STD concerns, so it’s best to use this method with a condom as well. Your birth-control sponge will contain spermicide.
- Spermicide. Speaking of spermicide, it’s a chemical you can put in your vagina to help prevent sperm from fertilizing an egg. It’s available in gel, cream, suppositories and film forms.
- Diaphragm. You would place this device, which is shaped like a dome, into your vagina to block your cervix. Similar to condoms, you need to ensure you’ve placed it correctly to maximize its effectiveness and you have to use it every time you have sex. You should also use it with spermicide.
- Cervical cap. Smaller than a diaphragm, a cervical cap is a bowl-shaped silicone device that goes in your vagina. It’s important to use spermicide with this method, and it’s only effective for about two days.
Fertility awareness options are less effective than hormonal options, and they require much more vigilance on your part as using these methods properly and effectively can be difficult. However, if getting off of hormones is important to you, it may be worth talking to your provider about what you can do.
- Withdrawal. Pulling out before ejaculation prevents the need for hormones, but it can still lead to unintended pregnancy.
- Natural family planning. Often called the rhythm method, this requires a high level of vigilance at tracking your body’s signs and only having unprotected sex at certain times of the month when you’re least likely to get pregnant. Many apps are available now to help you track your cycles. And one, Natural Cycles, was even recently certified as contraception in Europe.
Whatever you choose, it’s always best to make the decision with your provider, who can walk you through all your options and provide advice for making the most out of your choice. Make an appointment with a gynecologist at Lahey today.