Every month, LOLA invites members of our community to get together and chat about reproductive health and wellness. The latest event brought up a lot of questions about birth control: in particular, how to find the right option for you.
To answer this question further, LOLA turned to Dr. Corina Dunlap, a licensed naturopathic doctor and medical researcher who specializes in women’s health. Here’s what she wants you to know.
What should you consider when choosing birth control?
First things first: there are a lot of options out there these days when it comes to birth control. Before diving into research, take the time to ask yourself what you’re looking for. Here are a few questions to get you started:
• What stage of life are you at right now? Are you single, married, thinking about having kids in the next few years?
• How often are you having sex, what type, and with whom?
• If needed, are you open to using hormonal birth control, or would you rather explore other options?
• Are you okay taking a pill daily, or would you rather go with an option you don’t have to think about for a few years?
This exercise should help you figure out what your current priorities are when it comes to birth control, and help you plan ahead for any future life goals (like having a baby). It also helps you prepare for the next person you’ll want to talk about birth control: your doctor.
What should you ask your doctor about birth control?
This conversation is an important one, and will vary depending on where you are in life and what your priorities are. In particular, if you’re planning on having kids in the next few years you’ll want to ask your doctor how easy it will be to stop using contraception. If you decide you want to get pregnant quickly in the future, keep in mind an option like the IUD or an implant will have to be removed by a nurse or doctor.
Other important things to discuss with your doctor include:
• STI protection
• Common side effects
Also let your doctor know if you smoke or have any health conditions, including:
• Allergies, especially to copper or latex
• A disorder known as Wilson’s disease that allows too much copper to accumulate in the body
• A history of anxiety or depression
• Migraines or headaches
• A pelvic infection, such as pelvic inflammatory disease
• Uterine fibroids
• Unexplained or heavy vaginal bleeding
• A bleeding disorder
• Cardiovascular disease
• A history of blood clots
• Breast, uterine, cervical, or ovarian cancer
These factors can affect which kind of contraception your doctor recommends.
What types of birth control are available?
Want to do a bit more research on your own, before making a choice? Here’s a full rundown of birth control options.
Barrier or behavioral methods
Many women use barrier methods of birth control, all of which work by physically blocking sperm from getting to the egg. (Think: condoms, diaphragms, sponges, cervical caps, and spermicide.)
Others rely on behavioral methods, such as the practice of fertility awareness, which requires diligent tracking of one’s menstrual cycle. Typically, a woman using this method will use another form of birth control during the first half of her cycle and ovulation days, when she is most fertile.
Although convenient for some women, barrier and behavioral methods can be hard for a lot of people to use perfectly. Because human error comes into play, this makes them among the least effective forms of birth control. That said, male condoms are still the best way to protect yourself from a sexually transmitted infection (STI).
Short-acting hormonal contraception
Birth control with estrogen and progestin (or progestin-only) prevent pregnancy by stopping you from ovulating and thickening your cervical mucus, so sperm can’t get to your egg.
With typical use, these methods are about 91-94% effective. Popular options include:
• Daily oral contraception (commonly known as the Pill)
• Weekly birth control patches (formerly Ortho Evra, now available as Xulane)
• Monthly vaginal rings (a.k.a. the NuvaRing)
• Contraceptive injections, once every three months
Long-acting reversible contraception (LARC)
An IUD is a small, T-shaped device that your doctor inserts in your uterus through your cervix. Most IUDs are made of plastic and emit varying amounts of progestin. They can prevent pregnancy for 3-5 years, depending on which one you get.
The Paragard IUD is a hormone-free option made of copper, which is toxic to sperm. Another alternative is the contraceptive implant — a tiny rod that’s inserted under the skin of your upper arm by a doctor— which can prevent pregnancy for up to 3 years.
LARC methods are at least 99% effective.
To permanently prevent pregnancy, males can get a vasectomy to stop sperm from getting into semen. Females can get their “tubes tied” through tubal ligation, or Essure, a surgical device inserted into the tubes. Both cut off the sperm’s path to the egg.
If you have unprotected sex or your birth control fails — you forget to take your pill, the condom breaks — you can use the “morning-after pill.” Options like Plan B One-Step, My Way, Take Action, and Preventeza are available without a prescription and can help prevent pregnancy when taken within 72 hours of sex. You do need a prescription for ella, which works if you take it within 5 days (though you should take it as soon as possible).
Emergency contraception is not designed to be used as a regular form of birth control.
What are signs that your birth control isn’t working for you?
If you’ve already picked a birth control method, what can you expect, and how can you be sure it’s the right fit? Your doctor should tell you about any common side effects you might experience (including potential benefits, like a lighter period), but how can you tell what’s normal from what’s not?
Keep an eye out for any negative symptoms you experience after starting or changing your birth control. These could include: frequent vaginal or urinary infections, mood disturbances, acne, hair changes, stomach issues, weight changes, or a low sex-drive. Other possible complications could be more severe, including blood clots, pelvic pain, or dysfunctional bleeding.
You should also pay close attention to how birth control affects your mental health. Some women feel depressed or notice a decrease in their overall well-being, particularly when they take hormonal options. You may want to consider switching to something low or hormone-free if this happens to you.
Most importantly, make sure to tell your doctor as soon as something starts bothering you. They can usually help find a solution, which could include switching you to a different method. When birth control pills made me teary and nauseated, my OBGYN switched me to the Nuvaring. Since it has a lower dose of hormones and isn’t absorbed by the stomach, I experienced far fewer side effects.
So, how do you choose?
A healthcare professional can talk you through the pros and cons of all contraception. Your doctor wants to help you find an option that fits with your lifestyle.
And while it’s true that certain methods are more effective than others, the “best” birth control is the one that you will actually stick to.