Contraception & Family Planning
Family Planning Services
Family planning services are an important aspect of well-woman visits during the reproductive years. Whether your current objective is to prevent pregnancy, or you are ready to start or expand your family, your healthcare provider offers valuable support to help you along your path.
What is Birth Control?
Birth control is a vital aspect of family planning in which a woman chooses a method through which she wishes to prevent pregnancy. There are several methods of birth control or contraception. Each method falls into one of 3 categories: barrier methods, hormonal methods or permanent.
Barrier methods prevent pregnancy by inhibiting the sperm from reaching the egg. Hormonal methods prevent pregnancy by many methods including the prevention of egg release (ovulation), thinning effects on the endometrium to make uninhabitable to pregnancy, and changes in the cervical mucus to make it less permeable to sperm. Hormonal contraceptives have multiple other benefits including improvement in painful and heavy periods as well as treatment for acne, abnormal hair growth, cycle-related migraines as well as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Permanent methods of sterilization irreversibly scar the fallopian tubes to prevent fertilization.
Barrier methods of birth control include the condom (male and female), diaphragm, cervical cap, spermicide and sponge. These are non-hormonal options that are used at the time of intercourse to prevent sperm from reaching an egg for fertilization. Benefits to these options include less side effects, availability without a prescription and for condoms, protection against sexually transmitted diseases (STDs). These methods, however, are associated with higher rates of failure (as compared to hormonal options) and require a commitment to be placed before each sexual encounter.
Birth control pills are a common form of contraception many women use at some point in their reproductive years. These typically have both estrogen and progesterone although there are also progesterone-only forms. There are multiple brands on the market, varying slightly in the amount and form of hormone. These require daily use and therefore more reliability for them to remain efficacious. When used properly, these are an effective form of pregnancy prevention while remaining non-invasive.
The NuvaRing is an intravaginal ring that delivers hormones similar to the pill, which are absorbed by the lining of the vagina. The small, flexible device is inserted into the vagina much like you would a tampon and only requires placement monthly. You would place and remove the device yourself having a period before placing a new one.
Depo-Provera is a progesterone only form of birth control that is injected into the muscle for absorption. This form is longer acting than pills or the ring only requiring administration every 3 months.
Nexplanon is a semi-rigid, plastic device that is placed under the skin in the upper arm. This is a progesterone only form of birth control with slow release of hormone that is effective up to 3 years. Placement and removal are both performed in-office with local numbing medicine.
An IUD, or intrauterine device, is a T-shaped, flexible plastic device that is inserted into the uterus to prevent pregnancy. There are currently 5 FDA-approved brands which offer anywhere from 3-10 years of contraception depending on your choice of device. 4 of the devices (Mirena, Liletta, Kyleena, Skyla) are a progesterone only contraception, releasing hormone for 3-5 years; they vary in the amount of active hormone each has but are equally effective at preventing pregnancy. These devices can be placed and removed in the office during a pelvic exam; no anesthesia is required. Devices can always be removed prior to their expiration date if desired.
The only available non-hormonal method of prescription birth control is the
ParaGard IUD, an intrauterine device wrapped in copper that prevents pregnancy by inhibiting sperm motility and lifespan. This device is effective for up to 10 years and can be placed in office as other forms of IUDs.
What is “LARC”?
LARC is an acronym for Long Acting Reversible Contraceptives. These methods prevent pregnancy for several years after placement but the effects are reversible once removed. LARC includes Nexplanon, the arm implant, as well as all IUDs. These forms of contraception are among the most efficacious and require little to nothing for you to remember on a daily basis.
Permanent methods of birth control physically disrupt the fallopian tube which scars and prevents fertilization by blocking the female reproductive tract. This is often referred to as getting your “tubes tied”. These forms of birth control require a surgical procedure and can be performed hysteroscopically or laparoscopically.
***Please see the CDC chart to compare contraceptive efficacy.
Preconception Visit – Planning for Pregnancy
For centuries, women have been getting pregnant and having babies. Why is it that now we are concerned with a mother’s health before she becomes pregnant?
Research has determined that a woman’s health status prior to conception is a guide for her impending pregnancy. Preconception care enables you and your healthcare provider to identify any risks about which you would otherwise be unaware. The proactive steps that are taken from this care are intended to support the vital first weeks of fetal development.
You can receive a preconception health assessment once you decide you want to conceive, up to a year in advance of pregnancy. During this visit, your healthcare provider will evaluate your medical history and general health. Recommendations for nutrition, sleep, stress management, and dietary supplementation may all be made at this time. You can also learn how to chart ovulation and menstruation cycles so you better understand how to increase your opportunities to conceive naturally.
How Does Weight Affect Pregnancy?
A healthy weight is an important factor to a successful pregnancy. Studies have demonstrated that excess weight poses pregnancy risks including gestational diabetes, preterm birth, high blood pressure, preeclampsia, and more. Increased fetal growth due to obesity may cause a woman to need a cesarean section, and it increases the risk of birth injury. The risk of neural tube defects is also increased with obesity.
An underweight woman is also at risk for pregnancy complications, including preterm birth and low birth-weight. Babies who do not develop optimally are at risk during delivery and well after. Research suggests that low birth-weight babies are more likely to develop behavior or health problems during childhood and that these may extend into adulthood.
Other Factors That Affect Pregnancy
Lifestyle and environmental factors can impact the development of a healthy fetus. We advise mothers who intend to become pregnant to avoid alcohol and smoking. The first trimester is a crucial time for the growing fetus since mother is the primary source of nourishment. The presence of toxic chemicals in the body creates an immediate pregnancy risk, so cessation should occur well in advance, if possible.
A woman may avoid unhealthy lifestyle habits, but she also needs to know that hazards may be present in her home or work environment. During preconception care, we can discuss what to look for in your home and garden, as well as at work, to stop unknown exposure to radiation, solvents, pesticides, mercury, and other caustic substances.