During the discussion of medical insurance for birth control I started reading up on the various methods of birth control. Based on my experience with vitamins, depending on remembering to take a pill every day seemed like a chancy method and there were non trivial side effects and the long term costs are non-trivial. There seem to be other methods that are more reliable, cheaper, safer and more convenient.
-If you have severe reactions to Depo, the effects take 3-4 months to stop. Extremely violent mood swings are the most common reason I hear to go off Depo.
-if you have a negative reaction to Implanon, you have to have it pried out of your arm.
-not every woman can use an IUD - though insertion on a woman who has never had a baby is possible, it is more painful to insert with a higher chance of expulsion. And some women without children are simply poor candidates due to the size/angle of their cervix. Some doctors will not insert one in a nulliparous woman, though this POV is changing.
-The transdermal patches only come in 1 formulation - if its not a good match for you, you’re out of luck. Same for the Nuvaring (and some guys complain they can feel the ring during sex, that might be a sneakbrag though). Since there’s no generic you pay top shelf prices.
There are literally hundreds of different formulations of the Pill. If you have a bad reaction to one, you find another. Taking the pill every day is not rocket science.
All hormonal BC has a chance of side effects. The pill is by far the choice which is most adaptable and most reversible (as in “you stop any time”… Bad reaction? stop. want to get pregnant? stop…high blood pressure? stop.) It doesn’t involve any surgical procedures. Generics are widely available in many of the different pill types.
I never wanted an IUD because I was always afraid I’d get the associated cramping and some sort of rejection.
I was about to get Implanon but when I realized it didn’t have estrogen and I need estrogen to counter the symptoms of PCOS, I decided I’d rather take a pill than grow a beard.
I don’t know why women would rather use condoms than be on the pill. But if we weren’t all different there’d only be one kind of birth control instead of 20.
Depo has its own side effects, and doesn’t contain estrogen; IIRC it may not be as effective at dealing with certain things that the woman might want to use oral contraceptives for, like menstrual cramping.
IUDs rarely have side effects like expulsion or uterine perforation, but this may frighten some women. Also, gynecologists may be reluctant to prescribe them to women who are still considering children or are rather young. IUDs are also pricey, require a painful insertion procedure, and you don’t get a refund if it has unpleasant side effects (cramping, constant spotting, discomfort over lack of menstrual periods) or are expelled by your body.
Personally, I was on oral contraceptives for a couple of decades, for contraception, dysmenorrhea prevention, and eventually migraine prevention. These days I have a Mirena and like it, but I had zero complaints or side effects with oral contraceptives.
Birth control can be a little unpredictable, and so once you find one that works with your body, you tend to stick with it. Why would I risk being stuck with side-effects from Dep for months, when what I have now works perfectly fine?
A big plus is that i can get a one year prescription with my annual pelvic exam (which I need to do anyway) and pick that up in six month supplies. Compare that to inserting an IUD, which is a surgical procedure, and with having to deal with a full-on doctor’s appointment every three months with Dep.
Use of hormonal birth control can increase the risk of blood clots and stroke. I come from a family where young women in their 20’s and 30’s have had heart attacks, strokes, and blood clots due to genetic disorder that affects approximately 50% of my relatives. Those who are so unfortunate as to inherit that disorder are advised not to use the Pill due to the fact they are already at significantly higher risk and adding the Pill on top would just make their risk that much worse.
Just one reason. Granted, most women don’t have that worry, but some do.
is not (easily) reversible and is considered a permanent treatment. It’s technically sterilization as birth control. When I read the list initially I knew I’d heard of it but was thinking it was the no-hormones IUD, but it’s actually putting “plugs” in your Fallopian tubes, rather than surgically severing them. Nice for those who want it, expensive and useless for a woman who does want kids someday, or useless for someone who needs a hormonal treatment.
For me, the pill stops menstrual cramps, allows me to have a period that’s three days and barely need pads rather than seven days and frequent tampon+pad changes and mess, it also gives me clearer skin and smaller mood changes.
The pills are tiny, can be swallowed easily without water, and don’t have a bad taste, anyway. The very first thing I do when I get up for the day, without fail, is pee. So, the pills are in the bathroom where I take one every morning right after I pee. It’s not rocket science.
Because I loathe, loathe, loathe condoms. I’d almost rather not have sex than use a condom. If the Mirena IUD had been available when I was using non-permanent birth control, I’d’ve used that, but it wasn’t. Diaphrams are messy and unpleasant. And abstinence, well…that just isn’t an option.
Implanon and Depo cause huge, huge weight gain in many people. I am in the process of losing the 20 odd pounds I gained on it 5 years ago. It’s becoming more readily documented than it was years ago, so many aren’t choosing that route.
Mirena and the Patch are becoming more popular since it’s 3 weeks on, 1 week off, but that still requires a twice a month reminder of what to do when. Also, it’s shoving stuff up your cooter (Mirena) and a visible thing (patch) so that’s not gonna be appealing to everyone. There is no Mirena generic so retail it’s about $80 a pop if you don’t have insurance whereas many BC pills are super cheap generics, in some states as little as $10 for 3 months.
Essure is like a vasectomy. Why aren’t men getting vasectomies before they’re married?
An IUD is only good if you are monogamous and intend to be for the future. You basically have to be engaged or living together to get one because if you get an STD with one you are fucked-city.
It also takes a lotta nerve to get an IUD even if you are in a permanent, monogamous and you don’t want kids for awhile. And the first 3 periods were no walk in the park.
Managing my menstrual cramps was really important to me when I was younger, so I second this.
Now in my forties, it’s all about managing migraines. Depending on the formulation, birth control pills can also reduce or eliminate migraines which are triggered by normal hormonal changes. The intensity of the migraines can also be reduced. Since I started taking Yaz continuously, I have a (very manageable) migraine about once or twice every three months or so, compared to the nearly debilitating five or more a month I was experiencing.
Because all of those methods have their own non-trivial risks and long-term costs.
Implanon requires a surgical procedure to insert and another to remove, which opens you to risk of site infection, and if things go really, really wrong, cellulitis and so on from said infection. The incisions scar, and if it’s the same implantable birth control they had when I was a nipper, the implant itself makes a fairly noticeable lump in your arm.
Mirena can cause epic cramping, constant low-level (or not so low-level) bleeding, breast tenderness, headaches, and mood swings, plus there’s the risk it could perforate your uterus. Uterine perforation is a Bad Thing for a lot of reasons and can kill you. You have to get STD tested before you can get it, insertion hurts like a sumbitch if you’ve never had kids (and some docs still won’t put one in someone with no kids), you have to palpate your cervix every couple weeks to make sure it’s still there, and if your insurance doesn’t cover it, you were looking at $800 lump sum out of pocket when I got my first one 8 years ago. I don’t know offhand what they cost these days, but the way prices have gone up on everything else, I’d be astounded if it was less than a grand to get one now.
Depo can cause weight gain, constant low-level bleeding (or constant bleeding like a normal period), breast tenderness, headaches, and mood swings and you can’t just stop taking it. Once it’s in you, you’re stuck with it till it wears off 4 months or so later, plus you have to make (and pay for) a doctor’s appointment every 3 months to get it (and get jabbed with a needle on a regular basis, which is an absolute no-go for a lot of people.) If you want to come off it and start trying to conceive, it can take as long as 6 months to a year after your last injection for your fertility to return.
Essure is considered a permanent sterilization technique, and is a surgical procedure. I don’t know anyone personally who’s had it done, so I know least about the potential side effects of this one, but it’s clearly not for someone who still wants to have kids. Many doctors will flatly refuse to do the procedure on someone who doesn’t have kids, just the same as they’ll refuse to tie your tubes.
Then there are the perception issues. Most of the methods you’ve suggested have only been around the last 10-20 years, whereas the pill has been around for 50. The pill is much more established in people’s minds as being safe and effective, though that’s slowly changing as more alternative methods go from new-fangled to old hat. Birth control is a big deal, and people tend to be leery of taking a chance on some new thing nobody really knows much about. People were especially leery of Mirena at first because of the safety issues of IUDs in the 70’s.
And…well, most of us know at least one person who has tried one of these methods and had an absolutelyhorrific experience and there’s not really any alternative formulations of these things to try again, so the horror is what gets stuck in our lizard brains. With the pill, people can have equally bad experiences, but you can switch to another formulation and have a much better experience which over time builds up a much more positive perception of the pill over all.
raises hand I can vouch for Depo. I gained about 10 pounds, probably because my appetite went from very small to constant. It also makes my depression worse and causes perpetual breakouts.
But the thing it’s supposed to treat - my severe pain - it treats beautifully. And even my IBS has gone away. I have decided to treat the side effects and stay on it, but Depo was always a last resort. I had tried the Mirena, bled constantly and was in so much pain, had that removed after a year.
But yes, it’s terrifying to have to commit to a new BC method. I don’t think the OP is taking into account how often unpleasant (and sometimes debilitating) side effects come into play with hormonal birth control. If you don’t know how you’re going to react to something, you’re less likely to want to make a permanent or long-term commitment.
Taking a pill isn’t a big deal once you’re in the swing of it. You wash your face, brush your teeth, take your pill, and go to sleep. Birth control pills even come in 28-day blister packs so it’s easy to check if you took today’s pill.
When I saw commercials for NuvaRing, I thought that really I’m far more likely to forget about something I put inside my vagina three weeks ago than I am to forget to take a daily pill.
Of course, then I realized that I’d be so paranoid about somehow expelling the thing without noticing that I’d be checking for it hourly.