Birth Control

Many women think that because they are older and/or because they had a difficult time getting pregnant, birth control is not necessary. As long as you are not menopausal, birth control should be something you take seriously. Many older women fail to do so and because of this, a study by the Alan Guttmacher Institute showed that more than half of pregnancies in women over age 40 were unintended.

When choosing a method of birth control, you should consult with your health-care provider and choose the method best suited to you, based on your health and your comfort level with the various methods.

The Pill

If you have always used the birth control pill as your form of birth control, now that you are over age 35, your health-care provider may recommend using a different form of birth control. This is particularly true if you smoke, have high blood pressure, or have a history of blood clots or cancer. The pill is considered safe for most women over age 35 who do not meet these criteria.

The pill is considered 99-percent effective, but it offers no protection against STDs. You may want to consider one of the new types of pills, such as Seasonale or Seasonique, that allow you to go three months without having a period.

Barrier Methods

Barrier methods of birth control include the condom, diaphragm, cervical cap, shield, and sponge. The male condom is 84 to 98 percent effective at preventing pregnancy and has the added benefit of reducing the risk of transmission of most STDs. The female condom is 79 to 95 percent effective in preventing pregnancy.

The diaphragm, cervical cap, and shield are devices you insert to cover the cervix. They are used with spermicide to block sperm. These barrier methods must be left in place for six to eight hours after intercourse to be effective, and are between 68 and 94 percent effective, depending on the method. The cervical cap is less effective in women who have had a child. If you use a diaphragm, you need to be refitted after you have a baby because the size of your cervix may change. These methods do not protect against STDs.

The birth control pill is the most popular type of birth control for women of all ages. The second most popular is female sterilization, or tubal ligation.

The sponge is a cervical covering that comes pre-filled with spermicide. It is not as effective in women who have had a child (only 84 to 91 percent). Like other cervical methods of birth control, it has to be left in place after intercourse for 24 hours to be effective. It offers no protection against STDs.

IUD

The IUD, or intrauterine device, may be either a copper T-shaped device or a device containing the hormone progesterone that is placed in your uterus. The copper IUD prevents sperm from traveling to your fallopian tubes. The progesterone-containing IUD releases hormones that thicken your cervical mucous, preventing sperm from entering the uterus and preventing implantation. IUDs are 98 percent effective in preventing pregnancy, but they offer no protection against STDs.

Hormone-Releasing Methods

There are three methods of hormone delivery that don't involve taking pills. Depo-Provera is an injection of hormones you receive every three months. Lunelle is a monthly injection of hormones. The Patch (Ortho Evra) is an adhesive patch you leave in place on your skin for three weeks at a time and that releases hormones into your body to prevent ovulation. Nuva Ring is a ring that is placed in the vagina for three weeks at a time and releases hormones that prevent ovulation. These methods are 99 percent effective. They offer no protection against STDs.

Sterilization

Vasectomy, for men, and tubal ligation, for women, are surgical methods of permanently preventing pregnancy. In vasectomy, the vas deferens, the tube that carries sperm from the testicles, is cut, preventing the ejaculation of sperm. In tubal ligation, the fallopian tubes, which carry eggs from the ovaries to the uterus, are closed or shut so that eggs cannot travel through them.

The tubal ligation procedure is performed through a laparoscope. If the tubal ligation is performed postpartum (usually within 48 hours of delivery) or intrapartum (at the time of cesarean section), then they are tied and cut. The failure rate for postpartum or intrapartum tubal ligation may be higher than when tubal ligation is done in the non-pregnant state.

Both sterilization methods are considered 99 percent effective. Because they can be difficult to reverse, they should be chosen by adults who are certain they do not wish to have any more biological children.

Cycle Beads are an easy way to track your fertile days when using natural family planning. A simple loop of different colored beads with a marker you move forward allows you to be aware of your most fertile times. For more information, see the Cycle Beads website.

Essure is a nonsurgical sterilization method for women that involves placing small devices in each fallopian tube that cause scar tissue to grow and eventually make pregnancy impossible. It takes three months for this method to become completely effective, and another birth control method must be used in the meantime.

This method is also relatively new and there will be several years of post-marketing study to evaluate effectiveness. There is also good evidence to suggest that physician experience is important in correct placement; inexperienced physicians fail to insert the fallopian devices properly in up to 14 percent of cases.

Natural Family Planning

Natural family planning, or fertility awareness, is a method of birth control that relies upon knowledge of your cycle and abstinence during fertile periods. You need to chart your basal body temperature and/or test your cervical mucous to use this accurately. This type of birth control is not as effective for women over age 35, whose cycles may be becoming irregular. Natural family planning is only 75 percent effective in preventing pregnancy.

Emergency Contraception

As of this writing, the morning-after pill, or Plan B, was set to be sold over the counter. Within three days of unprotected sex, two pills are taken 12 hours apart and prevent a fertilized egg from implanting. This is not meant to be a regular form of birth control and is 75 to 89 percent effective.

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