WHAT IS BIRTH CONTROL?

 

What is Birth Control? What are all my options?

 

This is an overview. Please click on the specific birth control option you’re interested in to learn more about it!

 

Birth control is also called “Contraception,” and a “Contraceptive” is anything that prevents pregnancy.

 

For a basic refresher, a pregnancy happens when a man’s sperm combines with a woman’s egg. During sexual intercourse, typically when a man reaches climax (orgasm), he ejaculates his sperm into the woman’s vagina and the sperm “swim” through the cervix, into the uterus, into the fallopian tubes, in search of an egg. Some sperm can be released even before orgasm, however, in the pre-ejaculate fluid.

 

An egg is available only during ovulation, when a woman releases an egg from one of her ovaries. This usually happens only once a month, but the opportunity for the sperm and egg to meet lasts several days since the egg needs to journey from the ovary to the uterus through the fallopian tube.

 

All contraceptives try to interfere with this process in some way.

sperm meets egg cartoon

 

Every female, once she starts having periods, is at risk of getting pregnant at any time. Periods can be unpredictable. Usually the cycle is 28-35 days, with ovulation (an ovary releasing an egg) happening in the middle of it, but it can be different every cycle. Your body naturally produces estrogen and progesterone, and the levels change depending on where you are in your cycle. Click here for more information on periods and the menstrual cycle.

 

After sex, sperm can live in a woman’s body after unprotected sex for up to 7 days. Even if you try to time things exactly right, there is still a lot of room for error, and unpredictability. No wonder we have so many unintended or accidental pregnancies in the world!

 

If you live in a country that has access to resources to prevent pregnancy, there is no reason not to use them, or at least try. Yes, birth control options all have side effects, but no, they are not all bad, or have hormones in them.

 

This is everyone’s responsibility, to decrease the number of unwanted pregnancies. There are so many children in orphanages or unloving homes out there. They deserve better. The parents whose lives and/or careers were derailed by unexpected pregnancies deserve better. Abortion is not an answer, nor is it a replacement for good birth control. I am strongly pro-choice and am so glad that abortion exists as a last resort, but it would be best if we can act early and minimize the need for it in the first place.

 

Abortion is not an easy process for anyone. It is emotionally painful and heart-breaking, on top of the physical stress of it. It is about 10 times safer than going through with the pregnancy and giving birth, however, so more lives will be lost if we outlawed it. Also, having it as a legal option keeps women from trying to do it themselves at home, with coat hangers. I still cannot believe many governments are still trying to control women’s reproductive rights. No one should be involved in the decision other than the woman herself, her support network, and her doctor.

 

Ok, I’ll get off my soapbox now. Well, one last thing – it is NOT only the woman’s job to think about birth control. It is everybody’s problem!! We are working on more birth control options for men, other than condoms and permanent sterilization (Vasectomy, scroll to bottom of this page), though nothing else has been officially released yet. For now, everyone can help out by always having condoms available, and to actually be open to ALL of the contraceptive options. You never know if you’ll like it until you try it.

 

I’ll list the birth control options roughly from least to most effective.

 

birth control methods

Spermicide – a gel/foam/cream that kills sperm. Can be used with condoms or other barrier methods.

 

Withdrawal – or “Coitus Interruptus.” Just as it sounds, the man tries to “pull out” before he ejaculates. This can be hard to do, and is not reliable. Also, even if the semen does not land inside the woman’s body, there is still sperm in the pre-ejaculate fluid (“pre-cum”) and it’s possible to get pregnant just from that.

 

Timing – also known as “Fertility Awareness” or “Calendar Rhythm” method. The woman tries to track her cycle and predict when she is ovulating (an egg is released from an ovary) and thus this is when she is “fertile” and at risk of getting pregnant. She also tries to predict when she is not ovulating/not “fertile”, and therefore when it is safe to have intercourse. Every cycle is different, however, and is affected by stress, diet, and many other things. Even if you have regular periods, the exact time you ovulate can change every cycle.

 

Condoms – and other “Barrier” methods. There are so many types! – the female condom, cervical cap, sponge, diaphragm These rely on preventing or decreasing direct skin or fluid contact. These are the ONLY way to prevent getting HPV, a sexually transmitted infection

 

“The Pill” perhaps the most well-known birth control. You have to remember to take it every DAY. If you miss a day or two, you can try taking extra pills to catch up, but it may not be as effective. There are actually SO many different types of pills, with different doses of hormones (estrogen and progesterone).

 

A pack usually has 28 pills, but only 21 of them contain any medicine, the other 7 are actually blank/”sugar pills”. They are different colors so you won’t get confused.

birth control pill

 

During these 7 days, you will have bleeding like a period, since you won’t be exposed to the hormones for those 7 days. This is called a “withdrawal bleed” because it happens when the hormones are “withdrawn” (taken away). This is not a real period since it does not have an egg in it since birth control hormones keep you from ovulating.

 

You can choose to just not take a pill at all for those 7 days, but it’s good to keep the habit of taking a pill every day.

 

You can “control your periods” by choosing to SKIP the blank/sugar pills. If you keep taking the pills with hormones in them, you can skip having a “withdrawal bleed”/fake “period”. There are certain types of pills that let you have a “period” once a season, or even once a year! Ask your doctor. 

 

This does not always work perfectly, however. Every body is different, and especially when you start taking hormones, you can have light bleeding or spotting, sometimes for weeks or months, while your body adjusts. If you are trying to control your “periods” but are having difficulty, talk with your doctor.

 

“The Mini-Pill” – similar to the Pill, but it has only progesterone in it, no estrogen. Very finicky, you have to take it at the same time every DAY, within a few hours. For women who cannot have extra estrogen due to health reasons, or choose not to.

 

ALL 28 of these mini-pills in these packs are the same and have active medicine in them! The last 7 of the pack are not blank pills. As a result, you can’t really control your “periods” with this method. You would have irregular bleeding/spotting.

 

mini-pill progesterone only

 

“The Morning After Pill” – also known as “Emergency Contraception” or “Plan B.” This is NOT birth control, but I thought it was important to mention it. If for any reason you had unprotected sex (missed a pill, the condom broke, etc), don’t panic! You can try to decrease your chance of getting pregnant, if it’s been less than 120 hours/5 days. You can go to any pharmacy and buy it over the counter if you are at least 18 years old. If you are younger, you will need a doctor’s prescription. There are different types (some types only work up to 72 hours after unprotected sex), so it’s very important read the label and take it exactly as instructed. Some types require you to take TWO pills, spaced 12 hours apart, instead of just ONE. Though there is no known limit to how many times you can use it, your body is not meant to experience these hormones regularly, there are side effects, and it is usually much more expensive than getting actual birth control! 

birth control plan b emergency contraception
birth control emergency contraception

“The Patch” – combined estrogen and progesterone. A small patch you stick to the skin and change every WEEK. Like the pills, after 21 days of using it, you can plan to have your “period” during the last 7 days, so you won’t use a patch at all for those 7 days. You can also keep using it every week if you want to skip your “period”.

birth control patch

“The Ring” – combined estrogen and progesterone. A small hollow plastic ring you put in your vagina and change every MONTH. Like the pills, after 21 days of using it, you can plan to have your “period” during the last 7 days, so you will take out the ring for those 7 days. You can also just leave the ring in for the whole month if you want to skip your “period”.

birth control ring
birth control ring

“The Shot” – progesterone only. You need to get this every 3 months at a doctor’s office, usually in your arm. It does not have to be a full doctor’s visit, you can just come in for the shot with a nurse or medical assistant. Since it’s progesterone only, you would expect irregular bleeding/spotting and you cannot alter the pattern. Some women stop having “periods” completely. The biggest downside some women reported is increased appetite, leading to weight gain.

birth control shot

“The Rod”  aka the “Implant.” Progesterone only. A small, plastic toothpick-sized rod that is placed under the skin of your arm by your doctor. Good for 3-4 years! You don’t need to do anything once it’s in! If you don’t like it, you can take it out at ANY time and you can get pregnant right away as soon as it’s out. Thus, this counts as a “LARC” – Long Acting Reversible Contraceptive. Since it’s progesterone only, you would expect irregular bleeding/spotting and you cannot alter the pattern.

birth control implant rod next to arm

IUD (Intrauterine Device), hormone type progesterone only. A small plastic “Y-shaped” device that is placed into your uterus by your doctor (same way as a pap smear is done!) Good for 3-7 years, depending on what type you choose! You don’t need to do anything once it’s in! If you don’t like it, you can take it out at ANY time and you can get pregnant right away as soon as it’s out. Thus, this counts as a “LARC” – Long Acting Reversible Contraceptive. Its best effect is that it can make your “periods” lighter and shorter, and for 10-20% of women, STOP having “periods” completely! These are actually used for women with heavy bleeding, even if they don’t need it for birth control!

progesterone iud in hand
iud Mirena

IUD (Intrauterine Device), hormone-FREE type – a small copper “T-shaped” device that is placed into your uterus by your doctor (same way as a pap smear is done!) Good for 10-12 years!! You don’t need to do anything once it’s in! If you don’t like it, you can take it out at ANY time and you can get pregnant right away as soon as it’s out. Thus, this counts as a “LARC” – Long Acting Reversible Contraceptive. No hormones at all!! The only downside is that it can make your “periods” heavier.

copper iud

 

Finally, there is the option of PERMANENT birth control, called Sterilization.

 

A woman can get a “Tubal Ligation,” meaning her fallopian tubes are tied or cut so that future eggs cannot get from the ovaries to the uterus. This does NOT affect her sexual function at all, such as ability to get aroused or orgasm. This is a surgery that needs to be done under anesthesia in a hospital.

tubal ligation sterilization birth control

A man can get a “Vasectomy,” meaning his vas deferens tubes are cut so that future sperm cannot get from the testicles to the penis. This does NOT affect his sexual function, such as ability to get an erection or orgasm. This can be done under anesthesia in a hospital, OR in the office by a doctor with numbing medicine.

vasectomy sterilization

 

Comparing the two, Tubal Ligations are HIGHER risk since they REQUIRE a hospital and anesthesia (being put to sleep with medicines can be dangerous depending on what other health issues a person has). It is also a longer procedure, and have more scars formed afterwards compared to a Vasectomy, since the doctor has to cut into her belly. If she needs a future surgery involving her belly organs, such as a c-section or appendix taken out, the scar tissue makes it more complicated and sometimes impossible. If you had a lot of belly surgeries in the past, it might be impossible to get a Tubal Ligation altogether. Thus, I recommend that when possible, couples choose a Vasectomy instead of a Tubal Ligation if they are deciding between the two.

 

Although there are surgeries that claim to reverse or undo Tubal Ligations or Vasectomies, they work less than 50% of the time and are NOT covered by insurance, thus could cost you up to $10,000! BE SURE that you do not ever want to have a child (again) before getting permanent sterilization done.

 

FUN FACT: All the “LARC” (Long Acting Reversible Contraceptive) methods (IUDs and Implant/Rod) are BETTER at preventing pregnancy than Tubal Ligation permanent sterilization! when compared side by side, since fallopian tubes can grow back together, or the procedure might not have sealed off the entire tube. So not only are the IUD and Implant reversible (meaning you can change your mind if you decide you want a pregnancy in the future), they also work better!! 

 

We are working on trying to make a Tubal Ligation method that can be done in a doctor’s office. In the past, there was a type of coil called Essure that could be put into the fallopian tubes from below, using a telescope-like camera that goes into the uterus, called a “Hysteroscope,” but women reported painful side effects from it, so it was discontinued.

Essure sterilization
hysteroscopy
Essure hysteroscopy view

 

Gynecologist can use the hysteroscope to do many amazing surgeries! If interested, click here to learn more.

 

We are working on this important area every day, including a birth control pill and a birth control gel for men!!

 

If you have any questions, feel free to ask! Stay tuned for more posts with more details on each contraceptive option.

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Hi! I'm Dr. Toni, a carTOONIst. I empower, educate and advocate for women and minorities through my art and coaching, while traveling nomadically. I help others also follow our hearts and live true to themselves, no matter what others say!
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