Birth Control -- All the tools in the toolbox
It's a tricky subject for some of us. For others it's easy peasy. Some folks find the perfect form of birth
control, while others deal with unwanted side effects or mental unease from their chosen method. I've caught myself saying, "If only there were something highly effective that didn't fill me with hormones, destroy me emotionally, and didn't require getting an implant that could potentially migrate through my uterus and end in surgery." Some of this stuff can be scary when you don't know enough. Sometimes actually being knowledgable about certain side effects can turn you away from a method. Other times it puts your mind at ease. But either way knowledge is power, so lets have a quick run down of some of the most popular and effective birth control options, their ease of use, and potential side effects and risks.
Birth control pills are what most people think of when you talk about birth control. Lots of women begin taking them at a relatively early age and continue to take them until they decide to conceive. According to Planned Parenthood, the pill is about 99% effective with perfect use, but only about 91% effective with typical use. Typical use takes into account women who forget to take their pill at the same time every day, or who may tummy issues such as vomiting or diarrhea, which all impact the effectiveness of the pill. (I'll be discussing perfect and typical use in each section) It works by altering your hormones to prevent ovulation and thickening cervical fluid to make it more difficult for sperm to travel.
For some women the pill controls unwanted symptoms, such as acne, pain caused by endometriosis, and irregular periods. But for many the pill causes unwanted side effects, including weight gain, severe PMS, depression, mood swings, decreased sex drive, decreased vaginal lubrication during intercourse, nausea and headaches. Yet they are easy to get prescribed, come in many varieties, and are a go to for many women due to their convenience. If you take the pill as directed, you will most likely have regular periods. It is advertised that you can get pregnant immediately after quitting the pill, however there may be a correlation between long term hormonal birth control use and difficulty conceiving later on.
NuvaRing is a good option for women who don't mind a hormonal method, but don't want to remember to take a pill every day. The ring is inserted into the vagina, left there for three weeks, and taken out for a week and then replaced. The week without the ring is similar to the week of placebo or sugar pills at the end of the pack. During this week you are still protected, and this is likely the week you will have your period. The ring has the exact same effectiveness as the pill and works the same way. 99% effective with perfect use and 91% with typical use. If you use the ring as directed you will most likely maintain regular periods. The side effects are similar, but many women see a decrease in symptoms with the ring, since it is a lower dose than most pills.
The shot is a hormone shot that is administered by your doctor every three months. Most women choose this option out of convenience and effectiveness. The shot is also 99% effective when used perfectly, but if you don't get your shot on time every time the effectiveness drops to about 94%. It works similarly to the pill and the ring. The shot alters your hormones and causes the cervical fluid to thicken, making it difficult for sperm to travel, and it also prevents ovulation. Side effects include weight gain, headaches, hair loss or increase, depression, and nausea. Your periods may lighten or disappear completely. You might bleed for longer than usual or experience spotting between periods. Unlike the above mentioned methods, it is well documented that it can take up to 10 months after quitting the shot to successfully achieve pregnancy.
IUDs are increasing in popularity. One trip to your gynecologist and you can be protected for up to 10 or 12 years (depends on who you ask). The IUD is inserted through your cervix and into the uterus. Pain levels vary between women, from just uncomfortable to pain that feels like very severe cramps. If you're concerned about pain during insertion, you can talk to your doctor. Some recommend taking ibuprofen before your appointment, while others go as far as giving a numbing injection to the cervix. The IUD insertion does not take long, so no matter your pain tolerance, it's a short duration of pain for long term protection. There are lots of different IUDs on the market, but only one that is non-hormonal in the USA. They vary in size and length of insertion time, which are all factors influencing ease of insertion. Your doctor may suggest you get the IUD inserted during your period. This is because your cervix is more open, which makes it easier to insert, it also ensures you are not unknowingly pregnant. With all versions of the IUD there is also a small chance of uterine perforation. The IUD can also be expelled and pushed out of the vagina. If this happens, it's most likely within the first few months of having the IUD. This is why you must check the strings to see if your IUD is still in place. Hormonal IUDs are slightly more effective than non-hormonal/copper IUDs. Hormonal IUDs are about 99.8% effective and copper IUDs are about 99.4% effective. The perfect and typical use are the same for this method, because there is no possibility of user error. You don't have to remember to take it, all you have to do it set it and forget it. As long as it stays in place, you are protected. In the unlikely chance you get pregnant with an IUD it is more likely to be an ectopic pregnancy, so a positive pregnancy test requires an immediate trip to your doctor.
There are many hormonal IUDs on the market. They all work similarly. The most significant difference is size, amount of hormones, and duration of effectiveness. The smaller IUDs are only effective for 3 years, while the larger ones are effective for 5 years. We aren't completely sure how IUDs work. The current theory is that hormones in the IUD thicken cervical fluid and prevent ovulation. Side effects are similar to the shot. Spotting, lighter periods, or not having a period are all common with hormonal IUDs.
The only non-hormonal IUD available in the United States is Paragard. Paragard is a copper IUD that is shaped much like the hormonal IUDs, but instead of plastic infused with hormones, it is a plastic T wrapped in copper coils. The copper causes mild inflammation in the uterus. This is thought to cause a toxic environment for sperm and irritates the lining of the uterus. Some people believe there could be consequences of long term inflammation in the uterus. Paragard is currently the only doctor prescribed non-hormonal birth control method that is over 99% effective. Side effects include very heavy periods with large clots, longer periods, and no control over cycles (it won't regulate you like the pill would). The copper IUD can be used as emergency contraception if inserted up to 5 days after unprotected sex or a failed birth control method. The copper IUD is the method most controversial with the pro-life community. Since, it doesn't prevent ovulation there is always a chance an egg could be fertilized, but it wouldn't be able to implant due to the toxic nature of the uterus. This may be important to you depending on your opinions of when life begins.
Condoms are a go to for many people. Even folks who don't depend on them as their main form of birth control still use them, since they are the only form of birth control that also protects from STIs. They're easy to have on hand and are relatively effective. Male condoms are more effective than female condoms during typical use, this may be due to the popularity of male condoms and their ease of use in comparison. When condoms are used perfectly every single time they are about 98% effective, however with typical use (human error) they are about 82% effective. Which is still a pretty good go in the odds game. Pulling out while using a condom increases their effectiveness as well. There are no real side effects to condoms, unless you have a sensitivity to the materials used. There are many condoms on the market now for people with latex allergies and sensitivities. Maybe we can have an entire piece on condoms down later on. The varieties are endless. The disadvantage of using condoms that most people talk about is having to stop to put the condom on. This really isn't a huge deal, and you can make putting a condom on part of foreplay.
I cannot emphasize enough that no matter what form of birth control you use, you should also be using condoms if there is any risk of STI whatsoever. If you are not in a monogamous relationship with an individual whose status you know, please you a condom.
Withdrawal aka pulling out, doesn't get the credit it deserves. When done perfectly it's about 96% effective. There are no side effects, and the only down side is that the partner with the penis must be very in tune with their body. They must pull out in time and typically must be pretty experienced to do it correctly. Since it is difficult for some to pull out when they should, typical use is only 73% effective. This is still better than nothing. If you trust your partner, this may be the method for you. If you are inexperienced do not use this method. One pro tip if you rely exclusively on withdrawal, is to keep emergency contraception (such as Plan B) around just in case semen accidentally ends up on or near your vagina.
Fertility Awareness Method (FAM)
Fertility Awareness Method (FAM) is an amazing method for women who don't want to take hormones, have an implant, or an IUD. FAM is often confused with the rhythm method or other less effective methods, even by some professionals. FAM is separate and distinct. Sources state that when used perfectly FAM is 99.6% effective. The reason this method gets such a bad reputation is because it requires a person who is diligent in tracking their cycle and committed to taking the necessary steps every single day. It is also lumped with other less effective methods by professionals and others who don't understand the differences.
The rhythm method (or if you use any of those apps that automatically tell you your fertile week) works by predicting when you'll be ovulating. It takes your past cycles, compares that to when most women ovulate, and gives you a best guess of when you should be ovulating. This obviously doesn't take into account that cycles vary between women, that stress can alter you cycle, and that most women's cycle vary a few days from month to month. While the textbook cycle is 28 days long, some women's are much shorter and some longer. You can see how with so much variation, simply making an educated guess at when you might be ovulating could leave room for lots of error.
FAM is different. By following the rules, tracking your temperature every morning, and checking your cervical fluid every day, you can determine exactly when your fertile days are and know exactly when you've ovulated, every. single. cycle. No matter what else is going on in your life. But you have to follow the rules. No exceptions. So this method is not for people who know they won't track their cycles as they should, or who know they won't use protection or abstain during their fertile windows. This method should not be used by anyone who is not mature enough to handle the consequences of trying to cheat the method.
If FAM intrigues you I strongly suggest the reading through the Kindara website, downloaded the Kindara app, and reading the book Taking Charge of Your Fertility. They each go into details of the steps to use the method successfully. Not only is it a great method to prevent pregnancy, but it can also be used when you want to conceive. It's the only tool that allows you to learn significant amounts of information about your own natural cycle.
That's really it. There are many many more forms of birth control that I didn't discuss. The sponge, diaphragm, vasectomy, the implant, cervical cap, tubal ligation...the list goes on and on. Maybe I'll cover those another day. What's important is that you find a method that works for you, that you understand the potential side effects, it's effectiveness, and what it takes on your end to increase effectiveness of your method of choice. Be honest with yourself about how committed you are to making sure you use a certain method correctly. Have an open line of communication with your partner(s) about what you want to do if your birth control fails. If you aren't comfortable with this conversation, then you may want to consider the only form of birth control
that's 100% effective -- abstinence. What matters most is that you don't feel stuck, and that you are empowered to take control of your fertility in whatever way you deem fit.
The above chart shows multiple methods and their failure rates with perfect and typical use.