استشارة تنظيم النسل

A birth control consultation is a conversation about what you want from contraception and which method delivers it. There is no single best method. There is a method that fits your health, your tolerance for side effects, whether you want children later, and how much day-to-day attention you are willing to give it.

Dr. Adeeb Alshahrour, MD, FACOG, provides contraceptive counselling, prescriptions, and in-office IUD and implant placement at the Women's Health Center of Chicago.

What you can get here

• Long-acting reversible contraception (LARC). Hormonal and copper IUDs, and the arm implant. Placed in the office, effective for years, reversible at any time, and the most effective reversible methods available.
• Hormonal methods. Combined pill, progestin-only pill, patch, vaginal ring, and the injection.
• Barrier methods. Diaphragm fitting, and guidance on condom use.
• Emergency contraception, including a copper IUD, which is the most effective option and also leaves you with ongoing contraception.
• Permanent contraception. Tubal ligation and salpingectomy, and referral for vasectomy.
• Stopping. Removal of an IUD or implant when you want to conceive, or when a method is not suiting you. You never need a reason.

How well they actually work

The honest ranking, by pregnancies per 100 women in a year of typical use:

• Implant, IUD, and permanent methods — fewer than 1. These work whether or not you remember anything.
• The injection — around 4, mostly from late repeat doses.
• Pill, patch and ring — around 7, almost entirely from missed or late doses rather than method failure.
• Condoms — around 13.
• Withdrawal and fertility awareness — around 20 or higher, depending on the method and how rigorously it is followed.

The gap between perfect use and typical use is the whole story. A method you will actually use correctly beats a theoretically better method you will not. See how each method works and how well.

What happens at the visit

• History. Blood pressure, migraine with aura, smoking, clotting history, liver disease, breast cancer history, and current medications. Several of these determine whether estrogen-containing methods are safe for you, which is the main clinical decision in the room.
• Discussion. What you have tried, what went wrong, what you want — lighter periods, no periods, no hormones, nothing to remember, or nothing that affects future fertility.
• Exam. Not always needed. A pelvic exam is required to place an IUD or fit a diaphragm. It is not required to prescribe the pill.
• Same-visit placement. IUDs and implants can often be placed at the same appointment. Say when you book that this is what you want, so time is set aside.

You do not need a Pap smear to get birth control, and you do not need to be on your period to have an IUD placed.

What to expect afterwards

IUD placement takes a few minutes. Cramping during and for a day or two after is normal; take an anti-inflammatory beforehand. Hormonal IUDs typically cause irregular spotting for three to six months and then much lighter periods, often none. The copper IUD tends to make periods heavier and crampier, particularly at first, and contains no hormones at all. Full guide: the IUD.

The implant goes into the upper arm under local anesthetic. Unpredictable bleeding is the most common reason women stop it, and it is worth knowing that in advance.

Pills, patch and ring. Breakthrough bleeding, nausea and breast tenderness in the first two or three cycles usually settle. If they have not settled by three months, that is a reason to change method, not to persist. See the contraceptive pill.

The injection can cause irregular bleeding and takes longer than other methods for fertility to return — often several months after the last dose.

Fertility returns quickly after stopping most other methods, including immediately after IUD or implant removal.

Non-contraceptive benefits

Hormonal contraception is a genuine treatment for several conditions, not only a way of preventing pregnancy. It reduces heavy and painful periods, is used to manage PCOS and endometriosis, improves acne in many women, and helps premenstrual symptoms. Combined hormonal contraception also lowers the long-term risk of ovarian and endometrial cancer.

What birth control does not do

No contraceptive method protects against sexually transmitted infection except condoms. IUDs, implants, pills and tubal ligation do nothing against chlamydia, gonorrhea, HIV or herpes. Preventing pregnancy and preventing infection are two separate jobs — see STI testing.

Come back if

• You have missed doses and are unsure what to do
• Bleeding is still disruptive after three months on a new method
• You cannot feel your IUD strings, or you think it has moved
• You develop a new severe headache, migraine with visual aura, calf pain and swelling, chest pain or breathlessness — stop estrogen-containing methods and be seen urgently
• Your plans change and you want to conceive

Talk to us

• How each method works and how well
• The IUD: complete guide
• The contraceptive pill
• Tubal ligation and permanent birth control
• STI testing and treatment
• Book an appointment online

Medical disclaimer

This page is general health information, not medical advice for any individual. Which contraceptive is safe and appropriate for you depends on your medical history, your medications and your goals, and should be decided with a physician. Seek urgent care for chest pain, breathlessness, calf pain and swelling, or a sudden severe headache while using hormonal contraception.