Birth Control


When I discuss birth control, I follow a fairly constant scheme. First, I make sure you understand that 'if you have sex, you will get pregnant.' I make it as clear and simple as it gets. Do not say you were not warned. When people have sex, they get pregnant. Actually, this is WHY they have sex. At least in evolution, this is what keeps as around as a race or species. Now there is more to birth control than 'The Pill'. Read through the options and the special situations, and we will discuss these options when we meet. There is no 'perfect' method, and no method fits all. There are methods that are easier to use, and those that need more discipline to use. In all cases, condoms are recommended. Not only will they prevent pregnancy, but they are also recommended to prevent the transmission of sexually transmitted infections or STI's (STD's).

I would like to thank Amanda A, one of our patients (name used with permission), as her questions were the main drive behind making this page become what it is now.

Available options for Birth Control

    Safe Period, Calendar, Withdrawal Method
    Condoms
    Diaphragm
    Birth Control Pills
    Patch, Ring
    Depo Provera (The Shot)
    Progesterone Only Pills
    IUD (Intra Uterine Device)
    Tubal Ligation (Tying the Tubes)
    Vasectomy (Tying His Tubes)

Birth Control in special situations

    If you are breast feeding
    If you have a history or at high risk of developing clot (or cannot take Estrogen)
    If you smoke
    If you are having a C Section planned
    If you have irregular or heavy menstrual bleeding
    If you think you want no more children    Top of page    Back to options

Safe Period, Calendar and Withdrawal

I am not sure if these qualify for 'real' birth control status. They do work, they will delay pregnancy for a while, but they are unreliable. There are too many reason why they will fail, and they will at one point or the other.

So, if you do not mind getting pregnant, but just want to delay pregnancy a bit, you may chose one of these options. Mind you, we do recommend you use condoms for prevention of STI's (Safe Sex).

The safe periods and the calendar methods work as follows. We know that the egg only lives for about 24 hours, and sperm live for about 72 hours. So, by observing the pattern of your menstrual period, we calculate when you are expected to ovulate. We work out the life span of the egg and sperm, and add a couple of days for security, then you get your fertile period. Other days of your period are safe, you are unlikely to get pregnant during those days.

The down side of this method is that it takes away the from the passion and the natural flow of feelings. What if one thing leads to another, and you are in the Red Zone, or the fertile period? Will you just stop?

Withdrawal is when the male pulls out just before ejaculation. It needs a good control on his part, and again, takes away from the passion and the natural act. In addition, there are secretions that prepare the male for ejaculation, and even though they are hardly noticed they do contain sperm and may cause you to get pregnant. Top of page    Back to options

Condoms

Condoms are used by the male partner. They need to be put on before intercourse starts. It is not ok to use them only before ejaculation as there are sperm that may result in pregnancy in the 'pre-ejaculate' fluids. The male partner needs to withdraw his penis before he loses his erection, with the condom still on. In theory, condoms are very effective in preventing pregnancy, but in practice they may not be the most reliable. I would not recommend them as the only birth control method if you absolutely do not want a pregnancy. So, for example, if you are using them just to delay pregnancy for a few months or a year or so, they are ideal But if you have six children and pregnancy is out of the question, you may need to use a more reliable method as a backup.

Condoms may sometimes break, or may not be available at the time. You will need to use a back up method, probably Plan B, in this case.

Do note that following the Safe Sex recommendations, you should not have sex if your partner does not use condoms. You only need one event of unprotected intercourse to become pregnant, to catch Chlamydia or Gonorrhea, and even Hepatitis B and HIV.

Condoms are classically made of rubber-latex. They usually come pre-lubricated, and in different colors, sizes, shapes, etc. Some women notice irritation with use of condoms, which may be related to the chemicals in the lubricant.

Recently, there has been a new condom on the market that is Latex Free. The manufacturers have control. So, if you are allergic to latex, you still have a protection options with those new condoms.
 


Diaphragm

This is a barrier that the woman inserts in the vagina before having sex, and it has to stay in place for about 8 hours after intercourse. Alone, it is not a reliable method for preventing pregnancy. You have to use it with a special gel that kills sperms ("spermicide gel"). If used together, and used the proper way, it is  a fairly reliable method. It has the advantage of having no hormones and does not affect other systems or organs. It gives the woman control over her decision on birth control.

It does need some training to use, and needs to be carried with you together with the gel that kills sperm. When inserted, however, your partner may not even notice that it is in place.

As diaphragms come in different sizes, you need to come to the clinic for fitting. We try different sizes until we reach that size that you feel comfortable with, and yet would be effective in preventing pregnancy. You need to get used to putting it in place and remove it yourself. We will help you with some tips in how to to this. We will also make sure you know how to use it properly and how to apply the gel on the diaphragm.

When we find the proper size for you, we place an order to a US vendor. It usually arrives in less than 2-3 weeks. You might be able to order spermicide gel in your local pharmacy. If not, you can place an order online -- many US sites will ship to Canada.

When the real diaphragm arrives, you come in again, and try it in and out one last time, until you are confident that you can use it the proper way to prevent pregnancy.

As you can see, it takes a bit of motivation to get past the learning curve. Once you are over that, it is relatively straight forward. If you have 4 or 5 children, I might recommend other methods of birth control to try before you decide you want a diaphragm. If you have no children, and would not mind if you do get pregnant at some time, diaphragms are good for you.

Women will chose diaphragms if they cannot use hormones, or do not feel comfortable with the idea of the IUD, or just want to delay pregnancy for a few months or 1-2 years.
 


Birth Control Pills (BCP)

Also known as "combined pills", or simply "the pill". Some even equate the words birth control to the pill. For a long period of time it was the most commonly used method of preventing a pregnancy. The idea behind them is simple. Each pills contains 2 hormones, the female hormone Estrogen, and a Progesterone-like hormone (of different kinds). When these are taken as recommended, they prevent ovulation so no pregnancy occurs.

The hormone combination in the pills has many other effects, some are good while others are side effects. For examples, your monthly bleeding is reduced and menstrual pain is lower when you are on the pill. Also, your periods are more regular, predictable and can even be delayed for important social events. Acne and excess hair usually show improvement on the pill, and many women feel they have better skin. The pill can also be used to control endometriosis and reduce the amount of pain associated with it.

Some women notice increased weight gain on the pills, others notice a drop in their mood. Some are not comfortable with it due to nausea, breast tenderness or spotting and breakthrough bleeding. Serious side effects are luckily rare, but they can include blood clots in the legs or the lungs, stroke and liver tumors. There is an association between estrogen hormone and some types of breast cancer.

The pill needs to be taken daily, and you need to remember to take it at the same time of the day. If you miss one pill, take it as soon as you remember, and take the following one at its usual time. If you forget two pills, you need to take them ASAP, and the regular one at the same time as usual. You need to review the small booklet that comes with the pills, as what you do may be different if you are in the first or second half of your cycle. If you miss three pills in a row, you might reconsider whether this is a good method for you. In all cases, you will need to use a back up method for 10 days, as you may not be fully protected after you missed those pills.

You should not use birth control pills in any of these situations: a) if you think you may be pregnant, b) if you have migraines with aura, c) if you had clots in your legs or your lungs in the past, d) if you had a stroke or coronary heart disease, e) if you had liver tumours, breast masses, gall bladder disease, or irregular vaginal bleeding.    

Seasonique

One of my favorite choices. The name comes from the fact that while you are on this brand of birth control pill, you menstruate only once per season. This means you get your menstrual period once every three months, or 4 times a year.

When the birth control pill was first marketed, it was made in a way that makes you menstruate once every month, to make it as natural as possible. With more experience using the pill, and with the advance of our understanding of how hormones work, we started using the pills to delay periods to allow for important religious or social events like marriages or athletic competitions.

With more and more experience and science, the idea of having a menstrual period once every 3 months became a reality. This can be very helpful for athletes, students and busy women in general. There is no advantage in having a period every month, other than than if you are trying to get pregnant. If you are using birth control pills, then pregnancy is not an issue. You do not need to have a period every month, and the hormones in the pill will protect the lining of your uterus and will help you maintain your bone density. This is different from having no periods when you have, say PCOS, when your bones and uterus may be at risk.

You take them the same way you take regular birth control pills. One pill daily of the pink pills, until you reach the white pills when you are expected to have your period.

Patch, Ring, etc

These are just different ways of taking the hormones that are present in the Birth Control Pill. The Patch is, well, a patch that you put on your skin. It stay there for one week, and then needs to be changed. You then put on a second and a third, with each staying there for a week. The fourth week you don't use a patch. During this fourth week you will have your menstrual period. You should change where you put your patch every week. We will talk about this in more detail if you chose this method.

Some people find it better than the pills because you do not need to take a pill every day. Others feel less nausea with it. On the other hand sometimes you may get skin irritation.

The ring is made of special medical grade plastic that releases the hormones. It is put high up in the vagina. It fits in place for three weeks. The fourth week you should take it out and expect to have your period. When inserted properly, neither you nor your partner will feel the ring.
 


Depo Provera (The Birth Control Shot, or "the Shot")

This is a shot that you get once every three months. It has only one hormone in it, unlike the "Combined Birth Control Pills" (usually pills) that have two hormones. The shot is basically a high dose of the pregnancy hormone. As a result, you may not have menstrual periods while you are taking it, you may feel a little bit tender in your breasts, and you may feel a bit of bloating. Some women have noticed a 1-2 lb weight gain with it.

Its advantages include not having a periods for the duration of its use (recommended for up to 2 years of use). It does not have the female hormone Estrogen, so it is ok to take if you have history of blood clots, or you are at high risk of clotting. It may be used for women who are over the age of forty for both birth control and treatment of heavy or irregular periods. It is also a good options for moms after delivery who want to breast feed. This hormone has no effects on milk production.

A study published published recently recommended restricting use of depo provera by younger women to about 2 years as there were some concerns about loss of bone density. If you continue using it beyond two years, we recommend you engage in active exercise programs, take extra calcium and vitamin D. Talk to your family physician about your choice, and they may check your bone density of the you are at a high risk for loss of bone density.   


Progesterone Only Pill

Brand names include Mini Pill and Micro Nor. As the name implies, these pills have only one hormone. They differ from the regular or combined pills in that they need to be taken every day. Every day means every day.  You do not stop if you menstruate or if you have unexpected bleeding.

They are used mostly during breast feeding. You usually will not menstruate when you are breast feeding, and likely this will continue when you take these pills. Their side effects may be that you get irregular bleeding or spotting. Other side effects may be breast tenderness, and some women have had some mood changes with it.

You also need to remember to take it at about the same time of the day. They have a short life, so if you miss a pill, you may not be protected for about 10 days. You will need to use a backup method for 10 days. The same is true when you first start using them, 10 days backup.

If you cannot take Estrogen, you can take these pills. They do not have Estrogen in them.

Keep in mind, they are not the most effective method of birth control. Their efficacy increases when used during breast feeding. If you are using them during breast feeding, we recommend you switch to combined pills, or another method at some point. Visit your physician for options.

 
 
IUD or Intra Uterine Device

Well, I like IUD's. I think they are some of the best inventions made. Also, they are some of the best options to prevent pregnancy. The whole idea is, you have one inserted, once, and then you do not need to worry about getting pregnant again. (for the duration of the use of the IUD, usually 3 or 5 years).
I actually believe in them so much, I created a separate page for them. Please click here for more information.


Tubal Ligation (tying the tube)

I would like you to see this as a permanent method.  In other words, there is no "un-tying" of the tubes. The procedure is done in the OR in the hospital. We put you to sleep and insert a scope into the abdome. This is called laparoscopy, and consists of a special camera that helps us see the uterus, tubes and ovaries. We then introduce another long instrument and we do the procedure. To complete the procedure, we may use a metal clip or a plastic clip, or we may burn or cut the tube. I personally use the metal clip. You go home a few hours later, and can go to work within 1-2 days.

It does involve surgery, so all the risks of anesthesia and surgery are to be considered.  Again, this is a permanent procedure.  You may think that for sure you do not want to have any more children and you want a secure method of preventing pregnancy. Did you know that the IUD or the Birth Control Pills are actually more effective in preventing pregnancy than tying the tubes? They also have the options that IF you DO change your mind in the future, you can stop them and go ahead and try to get pregnant. Think of this until we meet, and we will talk about it in more detail then.

 


Vasectomy (tying his tubes)

This is a relatively simple procedure. It is done as an outpatient procedure, and usually under local freezing. Recovery is simple, and it is an effective method. Do talk to your partner about it. He will need to see his family physician to have this arranged.

 
Birth Control during Breast Feeding

You just had a baby, and he/she is taking all your time, effort and energy. There is no time for any more babies any time soon. You will want to consider options for birth control.  There are many options, actually. The only limitation is that you are breast feeding and you do not want anything that will affect the amount or quality of the milk that you give to your baby. You also may have some concerns about any medications that may be secreted in the breast milk and how this may affect your little one.

You can always use condoms, but as we said before, used alone, they may not be the most reliable. You can add a spermicidal gel with it for better efficiency. Similarly, you can use a diaphragm. I would just like to point out that you are probably overwhelmed with the baby. You may forget to stock gel or find it too uncomfortable to use vaginal products when you are breast feeding. The vaginal wall is usually thinned out and it may burn a bit with intercourse.

Combined (regular) birth control pills are better avoided, especially during the first few weeks until milk flow is established. The amount of hormones secreted in breast milk is so small, it virtually has no effect on your baby. The problem with the pills (whichever type you choose) is that you need to remember to take a pill every day. Your schedule is hectic, and His or Her Highness has no respect of day or night, or other people's rights to sleep. This may result in you missing your pill.

You can use the progesterone only pill (Mini Pill, Micro-Nor brands, or similar) that has only one hormone in it. This hormone has no effect on breast feeding. Their efficacy increases when used during breast feeding. If you use them during breast feeding, we recommend you switch to combined pills, or another method after some time. Visit your physician for options. The Shot (Depo Provera) has the same category of hormone, so is safe with breast feeding.

An IUD is a perfect choice. They have no effect on breast feeding, need no maintenance, and hardly require any effort on your part. Top of page    Back to options


Birth control options if you had history of Clots or cannot take Estrogen

There are some women who should avoid the use of Estrogen. The main reason for this is usually a personal or family history of clots in the legs or lungs. History of stroke or breast cancer or certain liver and gall bladder disease may be other reasons. These women should not take Birth Control Pills, the Patch or the Ring.

They can use condoms, diaphragm, the Shot, IUD, Progesterone only pills, and tying the tubes.

 


If you smoke and want Birth Control

You cannot take birth control pills if you are 35 years or older, and smoke. Same applies to the patch and the ring, basically, no Estrogen hormone. Now, if you ask me for advice, I will suggest you STOP SMOKING. Yes, you heard this before. It is not good for your health in general, etc etc.

If I cannot convince you to stop, or maybe until you do, here are some of the options you may use. Condoms are recommended as always. A diaphragm with spermicide gel, the Shot, progesterone only pill, IUD's and tying the tubes are all possible.


If you are having a C Section planned

Tying your tubes may be arranged at the time of the C Section. As we said above, tying your tubes should be regarded as a final decision, with consideration that there us no 'untying of the tubes'. If you had a few C Sections, and thought of it well in advance, we will arrange it at the time of a repeat C Section.

I find myself a bit hesitant when I meet someone for the first time for a C Section, and they seem to have taken the decision at the time they were in hospital. I think this decision needs to be well thought out.
 
 
If you have irregular or heavy menstrual bleeding

Depending on the cause of the bleeding and if there are other problems, for example fibroids, you will be offered different methods for treatment of the bleeding.

The methods that may also help decrease bleeding include birth control pills, the Shot and the Mirena IUD.

If you think you want no more children

While tying the tubes is often the first thing people will consider, basically all other options can be used as well, except the safe period, calendar and withdrawal. Now, for the most convenient, you may want to think of the IUD. It will prevent pregnancy for 5 years, is as effective as tying the tubes or better, and has the added advantage that if you happen to change your mind in the future, you still have the option open for becoming pregnancy.

Birth Control Options

 

© 2016 by Dr Abdel Hadi

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