Blog of the Society for Menstrual Cycle Research

Coming Off The Pill: Considering “forget-about-it” birth control?

May 30th, 2012 by Laura Wershler

If you quit the pill would you replace it with forget-about-it or mindful birth control?

How you feel about your body, your menstrual cycle and your sexual relationship(s) will influence your choice. Another consideration might be your attitude towards an unintended pregnancy.

Photo: Public Domain // LARC birth control methods are highly effective, in part, because women can "forget about them."

On the Coming off the Pill (COTP) MIND MAP GUIDE I proposed in an earlier post in this Coming Off The Pill series, mindful methods dominate the Birth Control branch: condom, spermicide, diaphragm, fertility awareness and copper IUD. Only the latter could be considered forget-about-it birth control.     Have it put in, then forget about it.

What got me thinking about this dichotomy is the Contraceptive CHOICE Project, a new study by researchers at Washington University School of Medicine in St. Louis. More than 7500 participants were free to choose, with all costs covered, from a range of contraceptives. (Diaphragms and fertility awareness training were not included.) Contraceptive failure rates over the course of the study were compared for the methods offered. The key result?

“Women who used birth-control pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.”

The difference in effectiveness was even more profound for women under 21 who used the pill, patch or ring. Their risk for unintended pregnancy with these methods, versus long-acting reversible contraceptives (LARCs), was almost twice as high as for older women.

The reason for the higher failure rates is human error. Women, and especially women under 21 it seems, don’t always remember to take their pills, change their patches, or check to ensure their rings haven’t fallen out. These methods require a certain degree of mindfulness. The reason that LARCs are more effective, according to senior author Dr. Jeffrey Peipert, is because women can forget about them after clinicians put the devices in place.

There are several things I find troubling about the researchers’ contention that forget-about-it birth control is better just because it’s more effective, and that these methods should be among the first offered to women by clinicians.

Firstly, they fail to acknowledge that many women do not tolerate these “forget-about-them” methods. Among the choices made available to study participants were the contraceptive shot, which I presume was Depo-Provera, and an unspecified hormonal implant. (Implants are slow-release hormonal devices inserted under the skin of a woman’s arm.) Side effects and ongoing problems with such methods abound, and are anything but forgettable. IUDs, both copper and the hormonal Mirena, have fewer drawbacks but they aren’t problem free either. Women experience a range of side effects with the copper IUD. As for the Mirena, some women love it, others hate it.

Secondly, the implication that women under 21 especially should be encouraged (perhaps coerced?) by clinicians to use forget-about-it LARC birth control methods just makes me sad. I get that preventing teen pregnancy is an important public health goal, but the potential for harm to young women’s overall health and psycho-sexual development by the use of such methods, Depo-Provera and contraceptive implants in particular, should be cause for caution and concern.

Maybe it’s time to research mindful birth control methods. Might more women choose barrier and fertility awareness based methods if expert training and support to ensure confident, effective use of these methods were provided free of charge, as were the expensive LARC methods in this study? I guarantee researchers would have no trouble finding women to participate.

  

10 Responses to “Coming Off The Pill: Considering “forget-about-it” birth control?”

  1. Women controlled by birth control. This is a disturbing trend indeed. And the methods they are promoting are not ‘safe’ or healthy for women.

    On the other hand – the abortion industry is doing quite well with birth control failures. I just posted an article on my blog about thousands of teens in the UK using abortion for birth control. Some teens have had up to 8 procedures.

    I believe the same thing is going on with STD prevention and the use of the HPV vaccines. It does not make sense that ACOG raised the minimum age for pap smears to age 21 when girls are having sex in their early teens…or younger.

    Once again, the conversation is lopsided – and does not allow for men to be accountable for their part in unplanned pregnancies or STI’s.

    All of this taking place at the same time that teen pregnancy rates are dropping.

    When one looks at the big picture of the control and objectification of women – these trends are frightening indeed.

    • Laura Wershler says:

      There are no easy answers to the many sexual and reproductive health issues facing women of all ages. Making informed choices and getting the best information we can to do so is paramount.

  2. smudgepuss says:

    When choosing my contraceptive, I wanted to minimise room for user error. Almost by definition, those methods are the least ‘mindful’. I know I’m fallible (my inability to take a 3-week course of anti-malarials on time every day taught me that!) and my IUD will sit there for the next 9 years merrily killing sperm.

    If I do end up with an unplanned pregnancy, the last thing I want on my mind while I’m trying to work out what to do with it is thoughts of ‘what did I do wrong? This is all my fault’.

    Bizarrely, I think I’m more aware of my forgettable IUD than I ever was of condoms. And I don’t just mean from the occasional prod in the uterus it gives me! I think it’s because I had to make a choice to use it – for most, I think, condoms are what you first use as a contraceptive before wondering if there’s something better out there for you (kind of similar to how most people grow up as meat eaters even if they later decide not to be).

    • Laura Wershler says:

      Thanks for your perspective. Your story confirms my uneasiness with Dr. Peipert’s claim that long-acting reversible contraceptives are more effective because women can just “forget about them.” Women who demonstrate your level of self-awareness and mindful decision-making deserve more respect.

      The “forget about them” comment strikes me as patriarchal and dismissive of women’s ability to make the best choice for themselves, even if it isn’t to use what Peipert claims his study has determined to be the best(ie most effective) birth control options.

      I think these researchers should have been more careful choosing the key messages they are using to sell their study results, and more upfront about the real health issues women may experience with these methods.

  3. [...] Read Full Article: Filed Under: Birth Control Pills/BCP's, Featured Post, Hormone Health US News, Unintended Pregnancy Tagged With: Birth Control, Birth Control Pill, unintended pregnancy [...]

  4. jemand says:

    My choice to use an IUD was partly due to my recognition of my own fallibility… but that wasn’t nearly the largest part of it.

    It was terror at the general drift of society and the fear of losing control over my own body and fertility. Every single time I walked into the pharmacy to get my ring prescription refilled I would wonder whether the pharmacist was going to refuse to do his job for some “conscience clause” and what would I do otherwise etc. etc. Every year when I went in to get a new prescription, I *resented* the condescending requirements that MADE me also undergo invasive pap smears etc. in order to just get a simple, safe prescription. I want to protect my health, understand, pap smears are fine and I would have gotten them anyway, but to make it a requirement for controlling my fertility? Like, I’m a woman, therefore the doctor knows best, and I ought to be lucky if I’m finally given my prescription and just go off quietly because they could, at any point, just *refuse* to help me.

    That did a HUGE number to me psychologically.

    Having a copper IUD? For the next 8 years, at LEAST, I am completely insulated from the broader society’s sticking their noses into my ladybusiness where they don’t belong. Possibly safe to let it go a little longer if I cannot find an accommodating doctor / insurance gets more invasive /judgmental etc.

    That’s why *I* chose “forgettable” birth control. I want *society* to do the forgetting and leave my damn uterus to my own uses.

    • Laura Wershler says:

      Thanks for your story. I applaud your mindfulness in your decision to choose the copper IUD.I’m glad it’s working well for you. What bothers me about Dr. Peipert’s comments, and the tone of the video in which he talks about the study (found here http://news.wustl.edu/news/Pages/23899.aspx)
      is his simplification of birth control decision-making and the paternalistic clinician control he implies. It is refreshing to hear stories like yours that push back strongly against such paternalism.

      I also appreciate this comment: “It was terror at the general drift of society and the fear of losing control over my own body and fertility.” This is a growing concern for many women. I wonder how many birth control decisions are being made with this concern in mind.

  5. Bravo – Well stated, Jemand. Women should have the right to safe and effective birth control without question. Period.

  6. [...] and tweeting about all the reasons they love their long-acting reversible contraceptives. I suspect Laura Wershler may have more to say about this [...]

  7. [...] I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week. [...]

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