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My name is Jenny Robinson.
I'm an OB/GYN at John Hopkins Bayview and I work
in the Women's Center for Family Planning, which is a sub-specialty
clinic that provides complex contraception care and also provides
care for women facing either abnormal or unplanned pregnancies.
Women who have high blood pressure, who have poorly controlled diabetes,
or a seizure disorder, they might be taking medications that can impact
how effective, for instance, the birth control pill might be.
Or there can be women that having pregnancies might actually be
detrimental to their health.
So a woman who's had a history of a blood clot, for example,
it would be really important for her to avoid pregnancy until
she's ready to plan it and can do so safely.
So that makes the choice of a safe and
effective birth control method a little bit more complex.
This is a chart that we often use when talking to
patients about what their contraceptive options are.
And it lays out all the different available contraceptive methods
by efficacy.
So the methods that you see at the very
top are the most effective ones.
So they have the lowest risk of failure,
the lowest risk of an unplanned pregnancy.
And those methods are the birth control implant,
the different versions of the IUD, or
sterilization, which is obviously permanent, so not necessarily
gonna meet the needs of somebody who does want future pregnancies.
The next tier down are other reversible methods,
which are more shorter acting.
So things like the Depo Provera shot, the birth control pill,
the contraceptive patch, the vaginal ring, or the diaphragm,
which is a barrier method.
And then, the bottom tier are the ones that have the highest
failure rate.
So those are methods such as male and female condoms, spermicide,
withdrawal, or periodic abstinence.
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So this is an example of one of the intrauterine devices,
which is a long-acting reversible birth control method.
This is the copper IUD, which is approved for use for
up to ten years.
So it's a nice option for
women who want a long-acting birth control method, but
don't wanna take away the option of having children in the future.
It's also a really nice method for women who want to avoid hormones,
since there's no hormone that's part of this IUD.
The way it prevents from pregnancy is the copper actually interferes
with how sperm are able to fertilize an egg.
So it doesn't change a woman's menstrual cycle and
there's no hormones in it whatsoever.
So if a woman has a medical reason why it would be unsafe for
her to use hormones, this might be a nice option for her.
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So other options within the family of intrauterine devices
are the hormonal IUD.
And there's currently two that are available.
One was designed for use for up to five years and
the other is designed for use for up to three years.
The major difference is the dose of hormone that's present in the IUD.
So the one that last for five years has a higher dose.
And the one that lasts only for three years,
is a little bit smaller.
So it's been specifically designed for
women who've never been pregnant before.
But both are options for women who have or have not been pregnant.
And the benefit of the hormone in the IUD is it tends to make
periods both shorter and lighter and less crampy.
So, not only do they provide really excellent pregnancy prevention, but
they can also treat conditions like heavy periods or painful periods.
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This is the birth control implant, which also has a hormone in it.
It's designed for use for up to three years.
And this is just a little flexible plastic rod that releases
the hormones slowly.
The rod is placed under the skin of the upper arm.
So it's not visible, but it should be palpable.
So if a woman were to run her finger over the area where the implant is,
she can feel it.
It's another example of forgettable birth control.
Once it's placed, you don't have to do anything else.
It's just there doing its job.
It can also reduce the amount of bleeding that a woman has during
her period,
although it can cause a person's periods to become irregular.
But it's very, very effective with a relatively low side effect profile.
So it's a nice option, again, for someone who's looking for
a long-acting but reversible birth control option.
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This is an example of the contraceptive vaginal ring.
So it falls in the same category as the birth control pill.
It has a similar combination of hormones in it as the pill,
which means it contains both estrogen and progesterone.
But instead of a pill that you have to take every day,
the ring is placed in the vagina just once a month.
So it's a little bit easier to manage if somebody is having a hard
time remembering a daily pill.
So the hormones get released into the vagina,
it's a very effective way of avoiding pregnancy and
has the same kinds of effects on periods as the pill does.
So it tends to make periods very predictable, and
also tends to reduce bleeding.
And it's really flexible.
I mean, some people get a little nervous about the idea of
placing and then removing the ring themselves,
which is how it's designed to be used.
But it's actually very easy to place and then take out.
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This is the updated version of the diaphragm,
which is a barrier birth control method.
So in the past, when women wanted to use the diaphragm it usually meant
coming into the office for a pelvic exam and
been fitted with a diaphragm of the appropriate size.
This version has been redesigned so
that one size will fit most women whether or not they have had a baby.
So it makes the act of getting the diaphragm a little bit easier.
And basically, it's designed to be used with a spermicidal gel.
So you place the spermicidal gel on the inside cup of the diaphragm, and
then the diaphragm gets placed in the vagina so
that it creates a physical barrier between the cervix and the uterus,
and the vagina.
So that sperm are blocked from being able to get inside the upper part of
the female reproductive tract.
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So in our clinic,
we do accept most insurance plans including Maryland Medicaid.
And most insurance plans do cover all of these contraceptive options,
including the long-acting reversible devices like the IUD and
the implant.
Some insurances, in the past, have required prior authorizations.
So patients would have to fill out an additional form before being
able to get the IUD.
But we've been able to streamline the process, a lot of times, so
that people can come in, have a visit with one of us, if they select
to use an implant or an IUD, very often we can place it the same day.
So it makes things a little bit more convenient.
It doesn't require people to come back at a later date.
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