Hormonal birth control beyond oral contraceptives

Dear Alice,

It looks to me like that the contraceptive patch and the NuvaRing work in a similar way, but I don't understand how the Mirena (or any IUD, really) works. Why might these methods be better than oral contraceptives that have been out for a long time?

— Thinking about trying a new method

Dear Thinking about trying a new method,

Good question! It's key to be in the know about a variety of birth control options, since new ones are being developed and may be a better "fit" for you than what you're currently using. You're correct in noting that the contraceptive patch and NuvaRing (the vaginal ring) work differently than Mirena, which is an intrauterine device (IUD). While they all use hormones, the primary difference is that IUDs are considered long-acting reversible contraception. This means after they're put in place by a health care provider, they require minimal maintenance and can last for years. The patch and vaginal ring require weekly or monthly maintenance to ensure effectiveness. This difference can contribute to a higher effectiveness rate, but it's key to note that one method isn't better than another. Each method has its pros and cons and the most appropriate one will be dependent on the needs and preferences of the person using it.

The contraceptive patch and the vaginal ring do work similarly. The contraceptive patch is essentially a sticker that is applied weekly to the surface of the skin that uses norelgestromin (a progestin) and ethinyl estradiol (an estrogen) to significantly decrease the chances of pregnancy. The vaginal ring is a small polymer ring that is inserted into the vagina for three weeks. It uses the same hormones as the patch to prevent pregnancy. The ring is then removed for one week, when a person experiences withdrawal bleeding (mimicking a period) — during that time, that individual is still protected from becoming pregnant. After their period has finished, a new ring can be inserted. For more specific information on these two methods, check out the related Q&As.

Mirena is a commercially-available, U.S. Food and Drug Administration (FDA)-approved IUD. IUDs are T-shaped contraceptive devices that are inserted by a health care provider that sit in a person's uterus, just past the cervix. Depending on which type a person uses, IUDs can prevent pregnancy from three to ten years and can be removed at any time by a health care provider. IUDs have proven to be as effective or even more effective than birth control pills (especially among those who have had a child or children), though specialists are still not certain as to precisely how they work. Hormone-releasing IUDs present various benefits, which include:

  • High efficacy: Hormonal IUDs have a high effectiveness rate, being over 99 percent effective. Because it's placed by a health care provider, there is little room for user error, 
  • Hormonal regulation: Hormonal IUDs release progestin into the uterus. A progestin hormone is also used in several progestin-only birth control pills, as well as in the Plan B emergency contraception method.
  • Lighter periods: Hormonal IUDs can help to regulate periods, making them lighter and reducing cramping for some. 
  • Convenience: A single insertion of a hormonal IUD can be effective for up to six years without the necessity of strictly adhering to a daily, weekly, or monthly contraceptive method. This means not having to remember to frequently take a pill or replace a patch or a ring. Some folks find that this enhances their sexual experiences.
  • Low cost: Although the initial medical exam, insertion, and follow-up appointments may be expensive, using an IUD may save you big bucks compared to the monthly cost of the pill, the patch, or the ring.

For more on the pros and cons of IUD use, see IUD (intrauterine devices): Another birth control option.

In the end, deciding between an IUD, the pill, the vaginal ring, the contraceptive patch, or any other method is a choice you can make with your health care provider and partner. Your provider can discuss with you the many options available for contraception and, dependent on your medical history, lifestyle, sexual activity, and any medication you might be taking, can recommend specific choices that would best suit you. Lastly, none of the methods of contraception mentioned above prevent against sexually transmitted infections (STIs). For this kind of protection, condoms (and other barrier methods) are still the most effective option.

Last updated Jul 12, 2019
Originally published Sep 12, 2003

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