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A primer on birth control and safer sex

by Eirish Sison 

Nearly 3 million women in the United States become pregnant by accident every year. That means almost half of all pregnancies in the U.S. each year are unintended, among the highest rates in a first-world country. The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 19 million new sexually-transmitted disease (STD) infections occur each year – that’s more than 100 every 3 minutes! Knowing these eye-opening facts, it’s become more important than ever for all sexually active people (and those who intend to be!) to learn how to have safer sex and prevent unwanted pregnancy.

With all the various birth control methods available on the market today, how effective is each option and how do you choose the one that's right for you? We asked Heather Corinna, former sexuality, contraception and abortion educator and counselor, and founder, director and designer of Scarleteen.com, an independent, grassroots sexuality education and support organization and website founded in 1998. In an email interview, Corinna said that the following are factors most people consider when choosing a birth control method, but underscored that the decision is an individual one:

• Effectiveness
• Ease of use
• Comfort with accessing and using a method
• Level of access to a method
• Cost
• Partner compliance (when needed)
• Health risks of a method
• Side effects (including the ways a given method can impact or influence sexual pleasure)
• Possible benefits beyond pregnancy prevention

While the various birth control methods discussed here are quite effective, it’s important to note that there is no such thing as 100% effective contraception or 0% STD risk if you’re engaging in partnered sex.

The information provided below is only intended as a quick guide to various reversible birth control methods. For more detailed information, especially on proper use and contraindications for different medications, consult your healthcare provider or pharmacist, visit the method manufacturer’s website or read the package insert.

Hormonal Methods

Hormonal birth control methods, such as the pill, the patch or an intrauterine device (IUD), rely on altering a woman’s natural hormone balance to prevent pregnancy. They can work one of several ways: by preventing ovulation, thickening cervical mucus to keep the sperm from joining the egg, thinning the uterine lining to make it less likely for a fertilized egg to implant, or a combination of these effects. 

Most women can use hormonal methods with little fuss, but some women experience bothersome side effects from the medications, including lighter or no periods, vaginal dryness, decrease in sexual desire, nausea, weight gain, more frequent or more severe headaches, mid-menstrual cycle spotting and mood changes. Some rare but serious complications that may arise are allergic reactions, blood clots, embolism or stroke, heart attack, gall bladder disease, thrombosis or eye problems.

A great benefit to using hormonal methods is that, when used correctly, they are the most effective contraceptives available to date. Another benefit is that there is nothing to do or put in place right before intercourse.

These methods all require a prescription. If you approach your sexual health care provider (who may also be your regular doctor) to get prescription for a hormonal birth control method, they will take a detailed medical history to help determine which method will be right for you. Be as honest and thorough as possible when you answer their questions, especially about pre-existing conditions and medicines you are currently taking. Some of these may cause serious complications, or reduce the effectiveness of a birth control method. Your healthcare provider may require that you undergo a pelvic exam, a pregnancy test or an STD test and/or treatment for an STD before prescribing you anything.

Keep in mind that hormonal birth control protects against pregnancy, but not against STDs. Unless you’re absolutely sure that you and your partner have both recently tested negative for STDs, use a condom during sexual intercourse even if you’re on hormonal birth control.

Combination Hormonal Methods:

These are called ‘combination’ hormonal birth control methods because they contain both estrogen and progestin which work in tandem to prevent pregnancy by preventing ovulation, thickening cervical mucus to block or immobilize sperm and thinning the uterine lining to make a fertilized egg less likely to implant. These methods are not recommended if you:

• Are over 35
• Smoke and don’t intend to quit anytime soon
• Suffer from migraine headaches
• Are currently breastfeeding
• Have sensitivity to estrogen or have had severe side-effects from previous use of a method containing estrogen

Birth Control Pill

If you choose this method, you have to commit to taking it on time every single day; even if you don’t think you’re going to have sex. The effectiveness of the pill drops if you take the pill at different times of the day, or miss taking a dose altogether. Most instances of birth control failure come from people not using the methods correctly and consistently.

Effectiveness: 99+% (perfect use); 91% (typical use)

Proper usage: Take one pill every day for the first three weeks. If you’re on a 21-day pack, you won’t have pills to take on the fourth week. If you’re on a 28-day pack, take a “reminder” pill (which does not contain hormones) every day on the fourth week. The pill is most effective when it’s taken at the same time each day, so choose a time when you’re most likely to remember, or set an alarm to help you.

You can use our free ovulation and period tracker iPhone app My Cycles to track your period and whether or not you’re taking your pill regularly.

Women remain protected against pregnancy and usually get their periods on the no-pill/reminder pill week. However, some choose to suppress their periods by going straight to a new pack of pills after the 21 active pills have been taken. If you want to do this, you’ll have to be vigilant about pregnancy symptoms since you won’t have a ‘missed period’ to alert you of a possible pregnancy. 

Safety of Suppressing Periods Over a Long Period of Time

“Last I checked, the longest-term study we had on using hormonal methods expressly to do that followed subjects for four years, and those studies did not find that there was any cause for concern,” said Corinna.  However, she also says that there have been no studies of this kind done on women under 18 and there are some things – like breast cell development – that may be affected in teens who have not completed puberty. All women, especially those 18 or younger, should consult their healthcare provider before they start using hormonal birth control to suppress periods.

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