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Birth Control: Your Contraception Options

Birth control (also known as contraceptives) is the practice of preventing an unintended pregnancy.

As a student, there are many factors to be considered when choosing a method that is right for you. The Choosely Wisely questionnaire will assist you in determining the best contraception for you based on your current needs and lifestyle.

Choosing the Right Contraception

Things to Consider

  • If your contraception method has failed, consult your pharmacist immediately and begin taking emergency contraception. Consider getting a prescription in advance as a precaution.
  • Abstinence, though not technically a form of birth control, can be up to 100% effective in preventing pregnancy and STIs. Abstinence has different meanings to different people. Define what it means to you.
  • Hormonal methods are the most effective birth control options and are reversible.
  • There are also permanent forms of birth control (e.g., vasectomy, tubal ligation). Talk to your healthcare provider for more information.
  • Consider all the facts before deciding on a form of birth control. Review these and other possible options with a healthcare provider and your partner(s) when deciding which is right for you. Ask lots of questions.

Oral Contraceptives ("The Pill")

What Is It?

The pill contains both estrogen and progestin that is taken orally. Progestin-only pills (“mini-pill”) can be prescribed to people who can’t take estrogen.

How It Works

One pill is taken every day, preventing the ovaries from releasing an egg. It thickens cervical mucus to prevent the passage of sperm and alters the lining of the uterus.

Effectiveness

  • Up to 99.7% effective in preventing pregnancy when taken correctly.

Advantages

  • Simple to take.
  • Can regulate periods, and decrease cramping.
  • May help improve acne.
  • Some are suited for continuous use. This means taking the pills without stopping. Your period will return when you stop taking the pills.  Discuss this option with your pharmacist or health care provider.

Disadvantages

  • Needs to be taken every day around the same time.
  • Side effects include irregular bleeding/spotting, nausea, bloating, breast tenderness, and headaches.
  • Increased risks for people over the age of 35 and people that smoke.
  • May increase the risk of blood clots.
  • Does not protect against sexually transmitted infections (STIs).

Vaginal Contraceptive Ring (NuvaRing)

What Is It?

A flexible ring containing estrogen and progestin that is inserted into the vagina. These hormones get slowly released. Pregnancy is then prevented by inhibiting the ovaries from releasing an egg. NuvaRing requires a prescription.

How It Works

The ring stays in the vagina for three weeks; then removed for one week. Like oral contraceptives, the ring prevents the ovary from releasing an egg, it thickens the cervical mucus, and causes changes in the lining of the uterus.

Effectiveness

  • Up to 99.7% effective in preventing pregnancy when used correctly.

Advantages

  • It is reversible.
  • Makes periods more regular, lighter, and shorter.
  • It does not interfere with intercourse.
  • For extended and continuous use, users can insert a new ring every three weeks.

Disadvantages

  • Side effects may include irregular bleeding/spotting, nausea, breast tenderness, and headaches.
  • May cause vaginal discomfort or irritation.
  • If a person stops using the ring it can take 1-2 months to return to a regular menstrual cycle.
  • Does not protect against STIs.

Intrauterine System, IUS (Jaydess or Mirena)

What Is It?

A T-shaped device that sits inside the uterus and contains the hormone levonorgestrel. It can be left in place for up to three years (Jaydess) or up to five years (Mirena). The IUS is inserted and removed by a health care provider, and requires a prescription.

How It Works

The IUS thickens the cervical mucus making it difficult for sperm to pass while causing changes in the lining of the uterus. This prevents sperm from fertilizing an egg. In some users it inhibits the ovaries from releasing an egg.

Effectiveness

  • The IUS is 99.9% effective in preventing pregnancy.

Advantages

  • It is long acting.
  • It does not interfere with intercourse.
  • It does not contain estrogen.
  • May decrease menstrual bleeding and cramping while some people can even stop having periods.
  • May decrease pain from endometriosis.

Disadvantages

  • Possible side effects after insertion include irregular bleeding/spotting.
  • Perforation of the uterus may occur at the time of insertion (but rare).
  • May fall out (expelled) in about 6% of people.
  • Does not protect against STIs.

Intrauterine Device, IUD

What Is It?

A T-shaped device that contains copper and sits inside the uterus for up to five years. It is inserted and removed by a health care provider.

How it works

The IUD acts as an irritant in the uterus and prevents the sperm from fertilizing the egg. IUDs cause changes in the lining of the uterus and in the cervical mucus. This prevents implantation.

Effectiveness

  • 99.4% effective against pregnancy.

Advantages

  • It is effective and long-acting.
  • It contains no hormones.
  • It is reversible.
  • It can also be used as emergency contraception if inserted within 5 days after unprotected sex.

Disadvantages

  • IUDs may increase menstrual bleeding or menstrual cramping.
  • Perforation of the uterus may occur at the time of insertion (but rare).
  • May fall out in 2-10% of people.
  • Side effects may include irregular bleeding or spotting.
  • Does not protect against STIs.

Male and Female Condoms

What Is It and How It Works

A soft disposable sheath that fits over the erect penis or inside the vagina that prevent semen from entering the vagina. Condoms are usually latex, but non-latex are available (polyurethane, silicone, lambskin). Condoms are available in stores, pharmacies, and online. Use a new condom for each act of intercourse.

Effectiveness

  • 85-98% effective in preventing pregnancy if used properly.

Advantages

  • Latex condoms help protect against most STIs.
  • Available without a prescription.

Disadvantages

  • Requires knowledge and practice of proper use.
  • Must be available at time of intercourse.
  • May slip or break.
  • May reduce sensitivity for either partner.
  • Must be stored and handled properly.

"The Patch"

What Is It and How It Works

A small patch that releases the hormones estrogen and progestin through the skin. It requires a new patch each week for three weeks and no patch for one week. A prescription is required. Like oral contraceptives, the patch inhibits the ovary from releasing an egg, it thickens the cervical mucus, and causes changes in the lining of the uterus.

Effectiveness

  • Up to 99.7% effective in preventing pregnancy when used correctly.

Advantages

  • It is reversible.
  • It may make periods more regular and decrease menstrual cramping.

Disadvantages

  • Side effects may include irregular bleeding or spotting, breast tenderness, and headaches.
  • Possible skin irritation where the patch is applied.
  • Patch may detach from skin.
  • May increase the risk of blood clots.
  • Does not protect against STIs.

Depo-Provera ("The Shot")

What Is It and How It Works

A hormone (progestin) injection that is given in the arm or buttocks every 12-13 weeks. A prescription is required. The injection is given by a health care provider. It prevents ovaries from releasing an egg, thickens the cervical mucus, and causes changes in uterus lining. Periods may stop altogether.

Effectiveness

  • Up to 97-99.7% effective in preventing pregnancy.

Advantages

  • Injections only occur 4 times per year.
  • It is reversible and does not contain estrogen.
  • It can be used by people who cannot take “the pill.”
  • Improves symptoms of endometriosis.

Disadvantages

  • Symptoms may include: irregular bleeding, decrease in bone density, depression, and weight gain.
  • May take up to nine months after the last injection for fertility to return.

Emergency Contraception (Plan B)

Emergency Contraceptives

Emergency contraception (EC) is a term used to describe a type of contraceptive, medicated or non-medicated, which can help decrease the chance of an unplanned pregnancy when used after unprotected sexual intercourse.

 Reasons why women choose to use emergency contraceptives:

  • Unprotected vaginal sexual intercourse,
  • Missing a dose of hormonal birth control or following a change in their birth control schedule,
  • Condom mishap (break/slip) post ejaculation, and
  • Forced unprotected sexual intercourse (sexual assault).

 There are three main forms of ECs available in Canada: two medicated hormonal options and one non-medicated option. It is important to remember these products are not intended to be used as your regular hormonal birth control.

 There are no medical contraindications for hormonal emergency contraceptives however, it is important to talk to your doctor and/or local pharmacist to determine which form of EC is right for you.

 

Emergency contraceptives are intended for emergency use only, not in place of regular birth control.

The Society of Obstetricians and Gynecologists

 

What Are Your Options?

Type of ECs

Levonorgestrel (LNG)

Ulipristal Acetate

Copper Intrauterine Device (Cu-IUD)

Also known as

Plan B®, Next Choice®, Backup Plan®

ella®

Liberte®, Mona Lisa®, Flexi T®

How does it work?

LNG temporarily stops the release of the egg from the ovary. This female hormone also causes changes to the lining of the uterus, making it more difficult for a fertilized egg to implant in the uterus.

Delaying ovulation by up to 5 days. ella® also changes the lining of the uterus, making it more difficult for the egg to implant in the uterus.

The Cu-IUD doesn't affect ovulation or the menstrual cycle; it immobilizes sperm travelling to the fallopian tubes, thereby preventing fertilization of an egg.

How do you use it?

1 or 2 medicated pills taken within 72 hours (3 days) of unprotected sex.

One pill taken within 120 hours (5 days) of unprotected sex.

A Cu-IUD must be inserted into the uterus by a health care provider within 7 days of unprotected sex.

Factors to consider

·   Must take within 72 hours,

·   Proven most effective for users weighing under 165lbs,

·   Safest method of EC if breastfeeding, and

·   May continue using regular birth control without interruption plus 7 days of abstinence or added barrier methods (e.g., condoms).

·   Must use within 120 hours,

·   Most effective for users under 220lbs, and

·   Wait 5 days before restarting regular birth control in addition to using extra barrier precautions for 14 days following unprotected sexual event.

·   Are the most effective at preventing unwanted pregnancies,

·   Are the most invasive, requiring a procedure for placement, and

·   Will take over as your regular form of birth control following insertion for up to 5 years or until user decides to have it removed by a health care provider.

When NOT to use

If already pregnant*

If already pregnant*

If already pregnant*

Side effects

Stomach pain, nausea, vomiting, and increased menstrual bleeding

Headache and nausea

Heavier periods for up to 6 months following insertion and abdominal cramping

Cost (at Campus Medicine Shoppe)

·   Next Choice® $19.35; with the Student Health Plan (SHP) $3.87.

·   Backup Plan® $21.92; SHP $4.38.

·   $42.35, not covered by the Student Health Plan.

·   Range from $70-140; SHP will cover reimburse up to 80% if claim submitted following insertion.

*Emergency contraceptives are not the same as the abortion pill and will not cause an abortion. Emergency contraceptives will not be provided by health care providers if the user is known to be already pregnant. If your period does not return within 21 days of using emergency contraceptives or if your period is already overdue, take a pregnancy test to ensure pregnancy has not already occurred.

 Birth Control - Your First Line of Defense

The best way to prevent unintended pregnancy is for all sexually active women to use effective regular birth control (BC) correctly and consistently. There are many different BC options including hormone pills, injections, and condoms, however, no one method is one-hundred percent effective at preventing unplanned pregnancy. If you are not already taking regular birth control or are not thinking about making a change, contact your health care provider to ensure your method is best for you.

 Where Can You Find Emergency Contraceptives?

Talking to your local Pharmacist is the quickest and most accessible place to start when seeking ECs, like the pharmacist at the Campus Medicine Shoppe! Your pharmacist can discuss each option with you, the pros and cons of each form of ECs, and is able to assess which form should be most effective for you.

After a quick consult, your Pharmacist can dispense LNG (Next Step®, Backup Plan®), provide a prescription for Ulipristal Acetate (ella®), or suggest you see a Physician or a Nurse Practitioner to discuss a Cu-IUD. If you are considering a Cu-IUD, you can book an appointment with a health care provider at the Student Wellness Centre on fourth floor Place Riel.

 Safety First

Emergency contraceptives will not protect you against sexually transmitted infections (STIs). It is important to remember to use condoms and other barrier methods in order to protect yourself against STIs when engaging in sexual activities.

 What to Expect After Using Emergency Contraceptives

ECs do not provide ongoing protection against pregnancy. Following EC use, it is important to return to your regular hormonal BC as directed. If you were not previously taking a BC this is a great opportunity to talk about your options with your health care provider.

Your period should return within 21 days of taking ECs. If your period does not return, it is advised that you take a pregnancy test.

As with any medication there are side effects you should be aware. General side effect of many ECs include:

  • Nausea,
  • Vomitting, and
  • Stomach/Menstural cramps.

If using the Cu-IUD, you should expect some discomfort upon insertion and possible cramping for a few days following. You may also experience spotting before your next period. Increased menstrual flow and cramping can occur during your next period.

 Although follow-up appointments are not neccessary following use of most ECs, always speak to your health care provider if you have any questions or concerns.

Additional Resources

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