The ABC’s of Birth Control

Choosing a birth control that suits you can be daunting. There are so many choices in so many forms, making it an overwhelming process. In this article, I will walk you through the ABCs of preventative birth control, emergency contraception, and abortion.

Preventative birth control

Barrier Methods 

Barrier methods work to prevent sperm from entering a uterus, therefore preventing pregnancy. 

Condoms

Condoms are a simple and accessible prevention method. They are unique in that they are the only preventative birth control method that also prevents STDs! Safe sex includes STD prevention, so condoms should be used in every sexual encounter involving genitalia, including anal sex. There are two types of condoms: regular and internal. Regular condoms cover the penis, while internal condoms are placed inside the vagina; both catch the sperm to prevent it from entering the vagina. It is important to note that regular and internal condoms should not be used together.  Theoretically, condoms are 95-98% effective when used properly every time. For proper condom use, it must be worn for the entirety of the encounter to prevent skin-on-skin contact. In reality, regular condoms are 85% effective, and internal condoms are 79% effective. For best practice, condoms should be used properly every time, and in conjunction with a second preventative birth control method. They are available in most pharmacies.

The pull-out method is often mentioned, however, it is only 78% effective. This is not an effective contraceptive method and should not be used alone. 

Hormonal Contraceptive

The magic behind many preventative birth control methods are two key hormones: estrogen and progestin. Methods that use estrogen work by inhibiting follicle-stimulating hormone (FSH), which prevents ovulation. Ovulation is a necessary step in being able to get pregnant, so preventing ovulation works to prevent pregnancy! Estrogen also regulates menstruation stability leading to a more regular cycle. Progestin is a synthetic hormone very similar to a naturally occurring hormone, progesterone. It thickens the mucus on the cervix which stops sperm from reaching the egg, as well as inhibits luteinizing hormone (LH), preventing ovulation. A benefit of progestin is that long-term use of progestin causes thinning of the endometrial lining, which can lead to a lighter flow! Preventative birth control methods are either a combination of estrogen and progestin, progestin-only, or non-hormonal. 

Birth Control Pills

Birth control pills can be either combination pills or progestin-only pills. When taken properly, they are 91% effective. They need to be taken daily, and some people find it difficult to remember to take them every day. Birth control pills can be associated with several side effects, especially the combination pills. These side effects include, but are not limited to: sore breasts, headaches and nausea, among others. Many side effects will subside after 2-3 months; if they persist, talk to your doctor about trying another option. One perk of the pill is that it can regulate and reduce pain associated with your period! For those planning on starting a family, birth control is not permanent and people can become pregnant as soon as they stop taking it. For McGill students, the Student Wellness Hub is able to provide prescriptions. For people in Quebec, your local CLSC is able to provide this service. 

Intrauterine Device (IUD)

An IUD is a small T-shaped plastic object that is placed in the uterus that contains progestin-only.  IUDs are currently the most effective birth control at more than 99% effective. One of the reasons they are so effective is that once they are inserted, they can be left for years. In fact, progestin IUDs can be left for 3-7 years depending on the brand. The downside to IUDs is that while insertion is quick, it can be quite uncomfortable. It is recommended to take painkillers before and to have someone accompany you just in case! For those who want to start a family, people are able to become pregnant immediately following the removal of the IUD. IUDs require a prescription and a doctor for insertion; this can be done at a CLSC. 

Birth Control Implant 

The implant is a very small rod, the size of a matchstick, that is inserted into your arm that releases progestin-only. To be implanted, there will be a little shot to numb your arm, then a special tool is used to put the implant under your skin. It may feel slightly irritated after, but the actual insertion does not hurt due to the numbing. If you get the implant within 5 days of the start of your period, you are protected from pregnancy immediately. Once it is implanted, it is effective for up to 5 years and is 99% effective. For those who want to start a family, people are able to become pregnant immediately following the removal of the implant. It has just recently been approved for use in Canada, and can also be done at the CLSC with a prescription. 

Vaginal Ring and Contraceptive Patch

Both of these methods are combination methods, using both estrogen and progestin, and are 91% effective! There are two main brands of vaginal rings, NuvaRing and ANNOVERA which have slightly different instructions. For NuvaRing, you place it in your vagina for 5 weeks, then replace it with a new ring. ANNOVERA is placed in your vagina for 3 weeks, taken out for one week, then reinserted. One ANNOVERA ring lasts for about 1 year, or 13 cycles. The patch is worn on your stomach, upper arm, butt or back and the hormones are absorbed through the skin. One patch should last for 1 week, and it is important to change the patch on the same day every week. Both require a prescription. 

Birth Control Shot

The birth control shot is an injection of progestin-only that you receive every 3 months. It is 94% effective, and is normally given by a doctor or a nurse, but if you are able, you can administer it to yourself. If the first shot is within 7 days after the start of your period then you are immediately protected against pregnancy.  For those who want to start a family, it can take up to 10 months after stopping the birth control shot to get pregnant. 

Non-hormonal Contraceptive

Copper IUDs

There is also a non-hormonal IUD option. It is wrapped in copper wiring which prevents the sperm from getting to the egg by changing the way the sperm swims. Just like hormonal IUDS, copper IUDs are also more than 99% effective. The copper IUD can be left for up to 12 years. Insertion procedures are identical to hormonal IUDS, and they can be acquired the same way.  Copper IUDs require a prescription and a doctor for insertion; this can be done at a CLSC. A negative side effect associated with copper IUDs are heavier periods and cramping. 

Note: The copper IUD is not only a preventative birth control method, but it can also be used as an emergency contraceptive! If it is inserted within 5 days of unprotected sex, it is more than 99.9% effective. 

Emergency Contraception

Emergency contraception is used in any case where a previous preventative method failed. This is not the same thing as an abortion, because emergency contraception prevents pregnancy before it happens. 

The “Morning-After” Pill

Most morning-after pills, including Plan B are levonorgestrel pills and can be within 3 days of unprotected sex. This will lower the chances of getting pregnant by 75-89%! While the morning-after pill does have some side effects like dizziness, nausea, they are not common. 

It is very important to note that levonorgestrel pills may not work for people who weigh over 155 pounds. The alternative is a morning-after pill called Ella, and unlike levonorgestrel pills, it requires a prescription. It has similar side effects to levonorgestrel pills and can be taken up to 5 days later. If you need emergency contraception within 5 days of taking Ella, it is important to take Ella again, not levonorgestrel pills. Ella lowers the chances of getting pregnant by 85%.

Abortion 

Abortion is the voluntary termination of a pregnancy and is a very important healthcare service. There are two possible abortion methods: surgical abortion and medical abortion. Medical abortion is done by taking an abortion pill. In Quebec, the age of consent for abortion is 14 and up. People 13 and younger require parental or guardian consent. It is free under health insurance, including people who have not yet received their health insurance card. In Quebec, you can find an abortion provider near you (you can find them here), and call them to book an appointment.  

Note: It is very important to talk to a medical professional before choosing the right birth control for you! It might take trying a couple of different options before finding one that works. Birth control should not make you feel sick and uncomfortable; if the side effects have not diminished after 3 months, talk to a doctor about switching. 

Edits and Contributions by: Amrita Sandhu