Long-Term Birth Control: New Implants and Patches

Birth control pills aren't for everyone. If you've forgotten your pills too many times -- or can't take them -- there are plenty of options.

The birth control patch (Ortho Evra), vaginal ring (NuvaRing), and three types of birth control implants (Mirena, Implanon, and Essure) offer long-term birth control that is virtually hassle-free for months, years, or forever.

If pregnancy is still a future possibility for you, make your choice carefully. With Ortho Evra, NuvaRing, and Mirena, fertility returns in one to two months. With Implanon, fertility will return a bit more slowly than with other methods.

Of course, just because fertility returns, pregnancy might not happen immediately, says Christopher Estes, MD, assistant professor of obstetrics and gynecology at the University of Miami School of Medicine. "It can take time, just as with regular old birth control pills." 

Only one device -- Essure -- provides permanent sterilization. "So far, it's 100% effective," he notes. "It's great for women who don't ever want to be pregnant." 

Ortho Evra: Birth Control Patch

For freedom from daily pills, many women are trying Ortho Evra. You can wear this birth control patch on your arm, your belly, or your backside. The patch is a small, flesh-colored square that is barely noticeable.

It's just as effective as the pill in preventing pregnancy. And it works in a similar method as birth control pills do. Each patch releases estrogen and progestin through your skin for seven days. You use a patch each week for three weeks, then no patch for one week -- and your period occurs.

"You have to remember it less often, so there's less chance for error," Estes says. The risks are the same as birth control pills or any combined hormone method, he adds. There are concerns, however, about higher risk of complications with the birth control patch.

Two studies of the patch produced conflicting results. Both showed no increased risk of heart attack, stroke, or death. However, one of the studies found twice the risk of nonfatal blood clots in the legs and lungs. (Birth control pills have also been associated with blood clots.) 

"The jury is still out on that," Estes tells WebMD. "If you ask my opinion and that of professionals around the world, we need more information. So far, it doesn't look like a significantly increased risk of blood clots. It's something that is still being looked into, but I have not counseled any patients to stop using the patch because of this."

Estes puts the risk into perspective: "Young, healthy nonsmokers have an extremely low risk of blood clots," he tells WebMD. "About 1 in 1,000 of those women will have a blood clot. If they take the pill, it's 3 in 1,000 -- still a very, very low risk. If the patch doubles that risk, it's still very low."