Are hormones the only answer?

I’m 32 and last year ended a 10-year relationship with a guy, and when I did so, ended a 14-year relationship with hormonal birth control. It’s been pretty cool watching and feeling my body seek out its own natural rhythms after all these years of pills and patches and rings telling it what to do when! However, I’m now in another monogamous relationship and have been reminded and reminded and reminded that I am really not a fan of condoms, and am thinking about other means of birth control again. My partner has great control in terms of withdrawing in time, but I still don’t like the general odds of that method and don’t want to rely on that alone…several of my friends have gotten IUDs inserted, but I understand they’re intended to be in place for 5 years or so, and I think I might want to start trying the baby thing before 5 years is up. I don’t really want to deal with diaphragms or sponges because they’re super-inconvenient and require messy spermicide. So…is it back to hormonal birth control for me?

Is there any documented downside to being on hormonal birth control for 15+ years? It seems so unnatural and not-wise to the secret health-nut/hippie/moon-goddess in me, even though my last form of protection, the NuvaRing, gave me no overt problems whatsoever.

An answer from Dr. Kate:

Good call on not relying on withdrawal. While it’s better than crossing your fingers, there are much better methods out there. I agree with you too on the sponges/diaphragms messy factor. I have a bias toward birth control you can use and forget about…hard to forget about it when you’re in the bathroom filling up your diaphragm with spermicide while he’s waiting for you in bed!

There’s no downside of long-term use of hormonal birth control. In fact, by using the pill/patch/ring for over 10 years, you’ve reduced your chances of ovarian cancer by 80 percent, and your chances of endometrial cancer by 50 percent. But if you don’t want to go back to the hormone hotel, I think an IUD is just the thing. Even though an IUD can last for 5-10 years, it doesn’t have to. I tell my patients that if they want to wait at least a year to try for pregnancy, an IUD is worth it, in terms of cost, fuss, and worry. So unless you’re looking at trying to conceive in 2009, I’d go for an IUD–it will make both your uterus and your inner moon-goddess happy.