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Health & Exercise Forum

Why "The Pill" may not be your best option

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Aug 21, 2017

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine (formerly The Commonwealth Medical College) – The 3rd Monday of every month!

Sabrina Brunozzi, MD2

Sabrina Brunozzi, MD2

Medical Advisor, Brian Wilcox, M.D.

Medical Advisor, Brian Wilcox, M.D.

 Guest Columnist: Sabrina Brunozzi; Medical Advisor: Brian Wilcox, MD 

Sabrina Brunozzi, MD2: This week’s article is written by Sabrina Brunozzi, a second year medical student at Geisinger Commonwealth School of Medicine and a Lackawanna County native. She majored in Biology and minored in Psychology at the University of the Sciences in Philadelphia and has a strong interest in women’s health. Sabrina is conducting ongoing research with Dr. Brian Wilcox regarding the usage of prophylactic antibiotics for gynecological surgery at Moses Taylor Hospital. The study is delivering valuable quality improvement information that local physicians can use to achieve better patient outcomes and comply with national guidelines set forth by ACOG for women’s pelvic surgeries.

What is the first thing that pops into your head when you think of birth control? If you are like the majority of patients who go to their gynecologist requesting a contraceptive, you probably just thought of “the pill”. Historically, when women think of birth control they automatically think of oral contraceptives, the patch, or the ring. In the past, these methods were the most recommended for preventing unwanted pregnancy. However, organizations like the American Congress of Obstetricians and Gynecologists, the World Health Organization, and the Centers for Disease Control and Prevention are now recommending other options that are safer, more effective, and have fewer side effects. In fact, long-acting reversible contraceptives (or LARCs for short) have the same effectiveness as sterilization, but are completely reversible in the case that a woman ever does desire to become pregnant.

LARC methods fall into two main categories: intrauterine devices (IUDs) or implants. An intrauterine device is a small, T-shaped plastic device that is inserted into the uterus right in your physician’s office. Intrauterine devices work in one of two ways. One type contains a hormone called levonorgestrel, which is a synthetic form of hormones produced naturally by the body. Levonorgestrel works by suppressing ovulation, increasing the thickness of cervical mucus which makes it harder for sperm to travel, and suppressing the growth of the lining of the uterus which makes it less likely that a fertilized egg will attach to it. The other type of intrauterine device is non-hormonal and works by using copper to inhibit sperm migration, which prevents fertilization of the egg.  Once inserted, the hormonal versions can be left in for 3-5 years depending on the model you choose, and the copper version can be left in for up to 10 years.

The implant is a small rod about the size of a matchstick that is inserted into the arm beneath the skin in your physician’s office. The area is numbed and the rod is inserted using a special applicator that does not require an incision. The implant contains etonogestrel and works similarly to the way the previously mentioned hormonal IUD works, and it protects against pregnancy for 3 years.

If the thought of not having to remember to take a daily pill for the next 3-10 years is starting to entice you, it gets better. LARCs:

  • Are more than 20x more effective in preventing unwanted pregnancy than the pill, patch, or the ring
  • Are as effective as sterilization (fewer than 1 in 100 unwanted pregnancies)
  • Can be removed if you change your mind and do wish to become pregnant at any time
  • Do not interfere with sex or daily activities
  • Don’t require any daily/weekly/monthly action by you
  • Are discrete so no one can tell that you are using birth control
  • Decrease heavy menstrual bleeding and cramps when using the hormonal forms

Like with any medical procedure, there are some risks associated with LARC usage. However, the risks are still small relative to the risks associated with other birth control methods and serious complications are rare. Some individuals experience spotting and irregular bleeding for the first 3-6 months of use, which is followed by complete absence of a period in most women. There is a slight risk of the IUD coming out of the uterus during the first year of usage (less than 5% of all cases), a 1 in 1,000 risk of the IUD piercing the uterine wall, and a less than 1 in 100 risk of pelvic inflammatory disease (an infection of the female reproductive organs). Although pregnancy is very rare using LARCs, if pregnancy does occur, the risk of the pregnancy being ectopic (outside the uterus) is slightly increased as well.  Of course, it is also important to note that birth control does not protect against the spread of sexually transmitted diseases and other protection methods should be used during sexual intercourse while using a LARC.

Overall, long-acting reversible contraceptives are more effective and safe than previously recommended birth control methods. They are great options for women who would like to prevent pregnancy for the next few years of their lives, but may still wish to have children in the future. They are also extremely convenient and do not require any follow-up action for a number of years after insertion. If you are thinking that a LARC is a good choice for you, please discuss which method is the best fit for you with your physician. In addition, you can find more information on the American Congress of Obstetricians and Gynecologists’ website at

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine (The Commonwealth Medical College).