Headlines and hype can leave women wondering what’s real and how best to take care of their health.
Last week several media outlets ran articles about a Danish study examining birth control and breast cancer. The headlines were alarming, but the actual level of risk was less so: After examining millions of bits of data, the researchers found one extra case of cancer for every 7690 women using the pill for a year. Not terribly newsworthy.
Is the link real? Probably. Doctors have long noted a detectable association between breast cancer and reproductive hormones including estrogen and progestins. Should you stop taking your pills or swap out your hormonal IUD for a hormone-free copper one? Probably not, if you want to be as healthy as possible and save parenthood for when you feel ready.
Which birth control is best for you depends on a bunch of factors because each contraceptive has its own profile of reliability, potential side effects, and, for some methods, bonus health benefits.
Here are a few facts that might help you decide which birth control method is for you:
· Contraceptives differ wildly in terms of how well they work for real people. In normal use, “natural” methods based on episodic abstinence are at the bottom of the reliability pyramid; about a quarter of couples using these methods get pregnant each year. (Yes, that’s 1 in 4, and despite what teachers may have told you in middle school, pledging full-on abstinence works even less well.) At the top of reliability are the “get it and forget it methods” – IUDs and implants that have an annual pregnancy rate of less than 1 in 500. In between abstinence and implants on the reliability scale lie hormonal methods like the Pill and ring; and below them lie barriers like condoms and diaphragms. Most couples find it hard to use an every-day or every-time method perfectly, so couples relying on the pill or barriers end up facing surprise pregnancy with surprising frequency: 1 in 11 each year on the Pill; 1 in 6 with condoms. If you’d prefer not having to choose between an unexpected abortion and an unexpected kid, which method you use is a big deal.
· Only condoms protect against sexually transmitted infections. Because of how they work—by getting your body to seal off the opening to the uterus—hormonal IUDs may offer some protection against pelvic infections. Intermittent abstinence methods like the rhythm method reduce opportunities for transmitting infections. But condoms are the only thing that provides substantial protection against most STIs. So, even if you choose something that works, say, 100 times better than condoms for pregnancy prevention, it’s still smart to “double Dutch” whenever STIs might be a risk.
· Net-net, hormonal birth control methods protect your health. According to Dr. Daniel Grossman at the University of California, “Breast cancer is only part of the picture. Hormonal contraception protects against several other cancers, while also sharply reducing the risk of dying during pregnancy. Studies looking at all causes of death find lower mortality among pill users compared to other women.” In other words, if your method of choice is the pill, patch, ring, or hormonal IUD, your total cancer risk and overall health risk is likely lower than it would have been with non-hormonal birth control or none at all. A list of health benefits by method can be found here.
· No one method is right for all women. Conditions like diabetes or heart disease or a history of breast cancer can rule out some methods for some women. And no medication is 100 percent risk free; there are people among us who have intense reactions to milk or peanut butter. The same is true for synthetic hormones. Even when that is not the case, nuisance side effects can be miserable, and it’s not possible to know who will get hit except by trial and error. Individual differences also dictate which bonus health benefits a woman might select. My daughters love their hormonal IUDs because they like having lighter, less frequent periods; but because of migraines I use a copper IUD. A friend with severe monthly cramps and bleeding found that the implant worked best to reduce her symptoms. Women who want the bonus benefit of less acne often choose pills containing estrogen; women with endometriosis often choose a method that suppresses menstrual cycling. You don’t have to remember all of this. Good teamwork means your healthcare provider brings to the table medical expertise, including expertise about how different birth control methods work while you bring expertise on your priorities and what has and hasn’t worked for you in the past. Never forget: It’s your body and your life and your provider is your paid consultant.
· Not contracepting or using less effective methods carries different health and mental health risks. Having a baby-capable reproductive system is complicated, and it carries a package of inherent risks. In the United States, about 800 women each year die from complications of pregnancy and childbearing (that is one pregnant woman in 5780), and tens of thousands are left with short-term or permanent health impacts. Mental health can be affected by the pregnancy process itself or the subsequent challenges of raising kids under adverse circumstances. For a woman who wants a child, these risks are well worth it; but about half of pregnancies, including those that created health problems, are unsought, even today. Being able to delay or limit pregnancy and bring kids into the world with a parenthood partner you love when you feel ready has huge health benefits.
Birth control isn’t perfect, and hopefully the options available to our daughters (and sons!) will be better than those available today. But we have options that our mothers and grandmothers could only have dreamed of. An array of reliable methods means that there’s at least one excellent choice for most women.