Contraception (Birth Control)
Females start on contraceptive medications for a variety of reasons. These reasons include preventing pregnancy, heavy or irregular periods, severe cramping, acne, taking another prescription drug that would make pregnancy dangerous, or evidence of a low estrogen state (such as missed or no periods).
If you decide to become sexually active, it is important to protect yourself from becoming pregnant. The simplest and safest choice for birth control is abstinence or not having sex at all. There is nothing wrong with waiting to have sex. In fact, more than 50% of all teens do not have sex.
One of the earliest forms of birth control is “the pill” and it is still the most widely used method of contraception today. Other great options are also available.
How does the pill and other contraceptives work? The pill and most other contraception work by giving you added hormones. These hormones, which are usually estrogen and progestin, prevent the release of an egg from your ovaries. Since pregnancy requires the union of a sperm and egg and there is no egg released, you will not get pregnant. Contraceptive medication also helps to stabilize conditions such as heavy periods, extreme cramping, and irregular cycles by providing a consistent and appropriate level of hormones in the body. It is important to use them correctly however as improper use will not prevent pregnancy or stabilize hormones.
BIRTH CONTROL PILL
What do I need to know about starting oral birth control, or “the pill”? First, for the first month you are on the pill, it is best to use a backup method of birth control to prevent pregnancy. There are several ways to start taking your pills. Options include starting on the first day of you next period (which is usually best if possible) or starting on any day.
Most birth control pills are packaged by the month, with 3 weeks of active hormones pills first, followed by 7 days of placebo pills or pills without hormones. The placebo pills are a different color than the active pills (some brands contain 24 days of active pills and 4 days of placebo pills). Usually you will get your period during the week of blanks. If you choose to bleed every month like a normal menstrual cycle you will need to take every pill in the pack and on the next day start a new pack.
How can I remember to take it? To be effective, pills MUST be taken every day around the same time. Most people find it easiest to remember if they take the pill when they do something else in their morning or nighttime routine. Some people even rubber band the pills to their toothbrush! It isn’t critical to take the pill at exactly the same time. For instance, taking the pill when you wake up at 6AM on weekdays and 10AM on weekends is fine.
When you start your pack of pills, use the stickers in the package to mark your start day. The day you start your pills should be the top left corner of the pack. This makes it easier to see that are remembering to take a pill every day. Cell phone alarms can also be very helpful – just be sure to have your pills with your when your alarm goes off!
What should I do if I miss a pill? If you forget a pill, take it as soon as you remember. If you forget for a whole day, take two pills the next day. If you two pills, take two pills one day and two pills the next day (you should never take more than 2 pills on a single day). You need to use a backup method for the remainder of the cycle and some spotting may occur. If you’ve missed more than three pills you will likely have some spotting or even a normal period. You are not protected against pregnancy. Start a new pack of pills the same way you started your first pack. Use a backup method of protection until you have completed the first week of your new pack.
What are side effects of the pill and other birth control? It is not unusual to have a little nausea or vomiting when first starting hormonal birth control. It usually resolves in the first week. You may also notice that during the first three months you have some irregular bleeding, which can be common with the start of any birth control. For most females, the pill does not cause weight gain or any other medical complications. In general, it is always best to call our office with problems or questions rather than stopping your pills.
What do I need to know about Depo-Provera? Depo-Provera, known more commonly just as Depo or “the shot”, is an injectable birth control. It contains Medroxyprogesterone, a form of progesterone. Just like with the pill, Depo is used to prevent pregnancy by inhibiting ovulation and by causing the cervical mucous to thicken. First, you will receive a prescription for Depo. You will pick up the prescription and bring it to the office so we can give you an injection (shot) of the medication once every three months. You do not need to use a backup method of birth control after you get your first injection. It’s very important to get your injections on time, every 11 to 13 weeks.
The initial injection will be given during the first 5 days of a normal menstrual period. You will return to the office once every three months for an injection. If you miss an injection, you can come in for the injection but will need to take a pregnancy test in the office first. If you miss and an injection, you must use a backup method of birth control until you get your next injection.
With Depo, females can experience changes with their periods. You may not get a period while you are on Depo, which is not harmful. You may notice that during the first three months you have some spotty or irregular bleeding. Other side effects include headache, dizziness, nausea, breast tenderness, weight loss or weight gain, acne, and changes in hair growth.
What do I need to know about Nuva Ring? Nuva Ring or “the ring” is an intravaginal birth control. It contains estrogen and progestin which slowly gets absorbed into your body. This small flexible disc can be squeezed into a slender shape with your fingers and inserted into the vagina by hand. Once the ring is inserted, leave it in for three weeks. After three weeks, remove the ring and throw it away. It cannot be flushed down the toilet. Do not insert another ring for one week as this will be the week of your period.
It is best to start using the ring when your next period starts. Ideally, insert the ring on day 5 of your period. Mark this day on your calendar and keep the ring in for three weeks. The ring takes seven days to become effective, so you will need an extra birth control method for your first seven days with the ring. It is unusual for the ring to fall out (even during exercise or sex), but if it does, simply rinse it off and re-insert it. You do not need an extra form of birth control if it falls out unless it has been out for three hours or more.
The ring is actually effective for 35 days. So if you forget to take it out after three weeks, you are still protected from pregnancy for two weeks. But it is best to mark your calendar because there is no pregnancy protection after 35 days. Most females cannot feel the ring once it is inserted into the vagina. You may experience lighter periods with less cramping while using the ring. You may also notice some irregular bleeding (or “spotting”), especially in the first three months of using the ring while your body gets used to the hormones. Side effects may include increased clear or white vaginal discharge, weight gain, headache, and nausea. Side effects with the ring are generally less noticeable than side effects with birth control pills.
What do I need to know about an IUD or implanted devices? An IUD, or intrauterine device, and implanted devices are long-acting and reversible contraceptive. These are great options for females looking for very effective contraception for several years. Additional advantages can include decreased menstrual bleeding and cramps and prevention of pelvic inflammatory disease. These are quick and minimally uncomfortable procedures. Most of our patients who have these devices are very satisfied with them. These can even be a great choice for females who do not wish to get pregnant for even one year as they are reversible once removed and can be removed early.
Nexplanon (an implanted device formerly known as Implanon) has been approved for 3 years of use. It is a 4cm long plastic rod implanted under the skin of your upper arm. The rod will slowly release hormones to inhibit ovulation and thicken the cervical mucus, which is similar to the way oral birth control works. We can easily implant this device in our office by one of our providers.
Other products include Paragard (an IUD approved for up to 10 years), the popular Mirena (approved to 5 years) and the newly approved Skyla (approved for 3 years). If you are interested in these devices, we will refer you to a nurse midwife or gynecologist.
How do I know what birth control is right for me? If you find yourself forgetting to take pills, oral birth control may not be the method of choice for you. Prior to starting any form of contraception, you will need to schedule an appointment with us and we will discuss your options with you.
What are the medical risks? There is an extremely low chance of blood clots for a female on many of the forms of birth control. As a comparison, normal pregnancy increases the chance of blood clots much more than birth control does. Females who smoke cigarettes are at an even higher risk for blood clots and even strokes and heart attacks. We do not recommend smoking in any individual but especially those who are on birth control.
What else should I know before I start birth control? Once you begin a birth control, we will need to see you back in the office in 3 months for a follow-up appointment. We will discuss your menstrual cycle and side effects and check your blood pressure (which can be elevated with birth control occasionally).
It is important to call us immediately if you to experience: severe abdominal pain, severe chest pain, cough, or shortness of breath, severe headache, dizziness, weakness or numbness, loss or blurring of vision, or severe leg pain in the calf or thigh.
Remember, only condoms are highly effective against sexually transmitted diseases. We recommend condoms are used 100% of the time with any other form of birth control for this reason. When used perfectly, less than 0.1% of women on the pill will become pregnant. The rate of unintended pregnancy goes up to 5% with imperfect use (which is why other forms can be a better choice). Keep in mind that in the United States one of every eight women between the ages of 15 and 19 becomes pregnant each year, most which are unintended.
Finally, remember no sex or abstinence is the best way to protect against disease and pregnancy. The choice should always be yours.