Brief Answer:
choice varies from case to case

Detailed Answer:
Hello XXXXXXX and welcome to health care magic,

I understand the issue. Though the question is a pretty direct one, the answer is not so simple or direct.

I will first explain the actions and advantages as well as disadvantages of all methods and then it needs to be individualised as per every case. Some methods may work for one patient but may be unsuitable for others and so on.

First about pills:
Pills contain the hormones estrogen and progesterone [ some have only progesterone called POP's]. They replace the natural hormone synthesis in our body and so do not allow the female egg to develop. They also make the uterine lining inconducive for the baby to attach and so prevent pregnancy. The main advantage is that they protect from ovarian cancers. The risk factors with them are that they cannot be used in women with heart disease, liver dysfunction, coagulation problems and many more [ so need to seek a doctor before beginning them]. However in most young women these issues are non existent so pills can be used. Unfortunately it is important to take the pill daily and if pills are missed, they no longer protect from pregnancy. May also cause irregular bleeding if taken irregularly.

If taken for long, most studies do not show any effect on fertility. The return to fertility is within 1-2 months in most women and may take upto 6 months in some.
Loop:
very good method as need not be used daily [ only one time insertion needed]. Loops act by preventing baby from attaching to the uterus as the loop itself is occupying space in the uterus. They also creat an environment preventing attachment of baby. Hormone loops modify the cervical mucus making it thick so sperms cannot go up. Hormone containing loops also protect from excessive bleeding and are good for women that have excessive bleeding during periods. However sometimes they may also cause irregular bleeding by changing the local hormone levels. Copper containing loops may cause heavy bleeding in the first few cycles. Loops may also cause painful periods for a few cycles until you get adjusted to it. Pain can be relieved by simple pain killers. Some women with loops may experience a few episodes of vaginal infections.
We advice loops only after atleast one successful pregnancy though they can be used by anyone. Copper T 380 A works for 10 years from date of insertion and multiload for 5 years. Hormone containing ones mostly work for a year and are expensive.

Having said all this I must add that none of the above methods prevent from sexually transmitted infections. Only condoms provide this protection. Also, it is best to use any hormonal or loop method after atleast one pregnancy when fertility has been proved. However you may use them safely even otherwise as they are not contraindicated. We recommend this as a precautionary measure. Condoms are the most recommended method until then.

So for women that have not yet had a pregnancy, condoms are the best as they protect from infection as well as prevent pregnancy.

For women with children, loops are best as need one time insertion and provide long lasting protection so no need for daily dose.

Pills can be used if there are irregular cycle, other associated problems like PCOD needing pill use, if patient prefers pills, protection from ovarian cancer desired [ if family history or so on] and in women that do not have any conditions that prevent them for pill use like heart, liver, breast disorders.
Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
[You may also ask me direct questions at the following link. http://doctor.healthcaremagic.com/doctors/dr-madhuri-n-bagde/66844 Thanks!!]

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Brief Answer:
IUD is a good choice

Detailed Answer:
Hello and welcome back,

As of now, with a 16 month old daughter, and if there are no problems with periods, an IUD is the most suitable one as it eliminates the need for daily intake of tablets and problems associated with forgetting tablets. A hormonal one may cause irregular periods or absent periods and can be used if this is not an issue. Copper ones do not alter periods. So choose as per your need.

If the periods are irregular then tablets can be used after prescription by a gynecologist [ need an examination before strating them] and they help regularize the periods in addition to providing contraception. Commonly used pills are ovral L, novelon, femilon. All are low dose pills and have good patient tolerance.

Hope this helps.

Dr Madhuri

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