Ask the Flight Surgeon / By CPT Abigail Vargo, M.D: Q: Doc, I want to get a prescription for birth control. What are my options while on flight status?
Homecoming ceremony at Fort Hood, Texas / U.S. Army photo by Spc. Sharla Lewis
FS: Prescription birth control is safe and considered a Class 2A medication – it must be prescribed by a physician and reported on the annual flight physical. Estrogen or progesterone preparations do not require a waiver when used solely for contraception or hormone replacement following menopause or hysterectomy. There are many effective methods to prevent pregnancy. Choosing a method can be difficult, but considerations should include your ability to use the method correctly and consistently, future pregnancy plans, side effects and cost.
Which birth control methods are most effective?
If used correctly and consistently, most hormonal birth control methods are greater than 99% effective. However, the effective rate can vary widely with different methods due to user error or forgetting to take medicines as prescribed. Barrier methods used at or near the time of sex (i.e. condom, diaphragm) tend to be less effective than other methods due to the increased potential for inconsistent or improper use. The Depo-Provera (medroxyprogesterone) injection, contraceptive patch, oral contraceptive pills (OCP), and contraceptive vaginal ring also need to be used consistently to remain effective. Intrauterine devices, implants, or surgery (i.e. vasectomy, hysterectomy, and tubal ligation) do not require the user to take any actions before sex and can be the most reliable methods, especially for forgetful users. With “typical” use the success rate of these methods ranges between 91-94%, but all potentially remain >99% effective when used exactly as prescribed.
Which method will be right for me?
No method is perfect; you should discuss the advantages and disadvantages of each with your flight surgeon. A major consideration should be your ability to use a given method both correctly and consistently to remain effective.
Intrauterine Devices (IUDs) – a healthcare provider must place IUDs into the uterus. You may need a temporary down-slip if pain medications are required to control the discomfort following placement. There are two types of IUDs: copper-containing (ParaGard) and progestin-releasing (Mirena, Liletta, Skyla). The copper-containing IUD interferes with both sperm transport and fertilization of an egg to prevent pregnancy and is effective for up to 10 years. The copper IUD may cause longer, heavier bleeding and more cramping. Progestin-releasing IUDs are effective for 3-5 years and work by altering the uterus and cervical mucous to prevent fertilization. Lighter or absent periods are common, along with less cramping.
Birth Control Implant – The Nexplanon (etonogestrel) implant is effective for 3 years. It is a soft, flexible, 4cm by 2mm implant inserted in the inner, upper arm by a healthcare provider. The implant slowly releases a hormone into the body to prevent pregnancy. A common side effect is irregular bleeding.
Injectable Birth Control – Depo-Provera (medroxyprogesterone) is a long-lasting progestin hormone, injected deep into a muscle (buttock or upper arm) once every three months and used for up to two years. During the first three to six months, periods may be irregular and prolonged, but periods may cease for up to 50% of women after one year of use.
Oral Contraceptive Pills (OCPs) – Most OCPs contain a combination of two hormones: progestin and estrogen. OCPs are very effective when taken as prescribed. Side effects typically improve with consistent daily use and may include nausea, breast tenderness, bloating, and mood changes. Irregular spotting or bleeding is common during the first few months and after missing a pill. Since estrogen increases the risk of developing blood clots, individuals with risk factors for clotting (tobacco use, are greater than 35 years old, or have a history of blood clots or cancer) should talk with their provider before starting. Progestin-only pills (Micronor, Camila, Errin, and Jolivette) do not contain estrogen, and they provide the same efficacy as combination pills if taken at the same time every day. Progestin-only pills do not increase the baseline risk of developing a blood clot.
Skin Patches – Patches contain the same hormones as the combination birth control pills and have similar side effects. Place a new patch on the skin weekly for three weeks, then leave off for one week.
Vaginal Ring – The NuvaRing (etonogestrel/ethinyl estradiol) is a flexible, plastic ring, which slowly releases estrogen and progestin, and has similar side effects to OCPs. One ring is placed in the vagina for three weeks, followed by a week with the ring removed.
In summary, it is important to discuss all your birth control options with a healthcare provider to determine which method will be best for you. If you have a procedure or get a prescription from a provider other than your flight surgeon, you must contact them before returning to flight duties as well as report these at each clinic visit.
Stay safe! Dr. Vargo
CPT (Dr.) Abigail Vargo is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.