Dr. Amy Hempel, OB/GYN at Virginia Physicians for Women, discusses the convenience, longevity, and effectiveness of various contraception options for established families..
Most of us went to our first OB/GYN appointment as teens looking for help with our heavy periods, cramping, acne, or contraception. We were handed pills and have been taking them until it was time to have children. But women’s needs can change after having kids – and it may be time to explore some new options. There are many types of birth control available to help meet your needs once your family is fully established. I’ll discuss the range of options from temporary to more permanent solutions, and your provider can help you find one that works best for your family.
Reversible Contraception
If you aren’t sure if you want more children, you might want to consider reversible birth control options. There are many more options than you might have been given at early visits to the gynecologist. Beyond condoms and pills, there are also contraceptive patches, vaginal rings, injections, implants, and intrauterine devices (IUDs).
The patch and the vaginal ring are, like the pill, combined hormonal methods of birth control. These methods combine estrogen and progestin to prevent ovulation. They help to regulate your period, make it lighter, and reduce cramping. If you like the idea of not having to take a pill every day, the patch only requires switching once a week, and the ring is inserted for 21 days at a time.
Birth control injections protect against pregnancy for 13 weeks, so you’ll only need to get an injection 4 times a year. Injections are given by an OB/GYN or other health care provider. It does take a little time to become pregnant after stopping injections, though. On average, it takes 10 months.
Implants and IUDs are long-acting, reversible contraception, sometimes referred to as “set it and forget it” methods. They last for several years, and you don’t have to remember to use them or worry about using them incorrectly. But when you are ready to stop using them, they can be removed at any time.
Some of these options may help with menstrual cycles more than others. If you have certain medical problems such as migraines with aura or high blood pressure, or if you are a smoker, you may need to exclude certain forms of contraception. Your provider can help you find an option that meets your needs.
Permanent Contraception
If your family is complete, you and your partner can also consider more permanent options of contraception.
Tubal ligation
Tubal ligation, commonly referred to as tubal sterilization or “getting your tubes tied,” is a surgical procedure to permanently prevent pregnancy. The procedure involves blocking or cutting the fallopian tubes to prevent sperm from reaching an egg.
Tubal ligation can be done immediately after delivery at some hospitals, or 6 weeks postpartum. If you opt to undergo tubal ligation after delivery of your baby, your procedure will be done using your existing epidural or spinal injection of medication while you are still admitted. Your restrictions after surgery include no heavy lifting for 6 weeks. You’ll need to talk to your doctor in the weeks leading up to your due date if you’d like to go this route so that they can plan to perform the tubal ligation after delivering your baby.
If you wait to have your tubal ligation until 6 weeks postpartum, you will undergo outpatient laparoscopic surgery and receive general anesthesia. Your doctor will either make one small incision at your belly button to place a ring on your fallopian tubes; or you may discuss complete removal of your fallopian tubes to decrease your risk of ovarian cancer.
Tubal reversal
While tubal ligation is meant to be a permanent form of birth control, there are times when women undergo tubal ligation and then decide they would like to have more children. Some patients can be considered for tubal reversal, although the odds of becoming pregnant following tubal reversal vary greatly with age and other factors. These factors include the type of ligation and amount of damage to the tubes as well as any fertility issues you or your partner may have. Younger women have a better chance of becoming pregnant after reversal.
VPFW physicians do not perform the tubal ligation reversal procedure, so it would require seeing another physician for the surgery. If reversal is successful and you become pregnant, you can resume your obstetric care with VPFW. You will require close monitoring, as tubal reversal comes with increased risk of tubal pregnancy.
If you are considering reversal, speak with your OB/GYN to determine if you would be a good candidate. You can also discuss other options including IVF.
Vasectomy
Of course, don’t forget your partner can get involved too. Vasectomy is a safe, outpatient procedure with minimal risks and recovery. This option is an equally effective permanent option for contraception once your family is complete.
Which options are most effective?
With regard to efficacy, the contraceptive implant is most effective at 99.95%, followed by the IUD at 99.8%, vasectomy at 99.8% and tubal ligation at 99.5%.
If you are unsure regarding permanent sterilization, an IUD or implant is a wonderful option that can also help with heavy bleeding, cramping or pain symptoms all the way to menopause around age 50.
It’s a personal decision, but we’re here to help.
Ultimately, choosing your birth control options after having children is a very personal decision. There are many variables to consider, but we’re happy to help you find the right solution for you and your family.
To schedule an appointment with a VPFW provider, you can call 804-897-2100 or set an appointment online.
About Dr. Amy Hempel
Dr. Amy Hempel, M.D., is an OB/GYN at Virginia Physicians for Women with special interests in basic infertility, adolescent gynecology, and low intervention birth. She was inspired to go into medicine after hearing about her own parents’ struggles with infertility and pursued obstetrics and gynecology so that she could help her patients through the challenges of starting a family. Dr. Hempel and her husband reside in Richmond, and she sees patients at the St. Francis and Prince George offices of VPFW. Learn about Dr. Hempel’s practice at VPFW.com.
