The Smart Girl's Guide to Contraceptives
You're no rookie when it comes to birth control. You've carefully selected condoms, compared notes with friends about various brands of the Pill, and culled as much info as possible during the frantic 15 minutes a year you spend with your gyno. Still, when it comes to preventing pregnancy some aspects of protection leave you curious Ã¢â‚¬” maybe even a little worried. So we asked the top doctors in the contraception field to address our most common queries. Have a few more? Jot them down and hand 'em to your doc at the start of your appointment Ã¢â‚¬” because it sure is easy for a girl's mind to go blank when faced with the business end of a speculum. Visit the Women's Health Sexual Resource Center for answers to all your questions.
I'm traveling for a month and don't want to bother taking a pill. Can I switch to, say, the NuvaRing and go back to the Pill when I get home?
Yes. It's fine to use a different method for a single month every once in a while, says Lee P. Shulman, M.D., professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine. But you may notice an increase in cramping or mood swings if the new product contains a higher or lower dose of hormones, or a different progestin, than your usual method. Just be sure to go back to your old birth control method ASAP. The effectiveness of any contraceptive relates directly to how consistently you use it. Once a year isn't a big deal, but hopping methods every other month will up your odds of getting pregnant. Here's how to make the switch: On the day you'd normally start a new pack of pills, insert the ring. Remove it 3 weeks later. Then, after another 7 days, start your new pack of pills.
I'm flying to Madrid for a week. Do I have to take the Pill according to my home time zone?
It depends if you're taking a "combination" or progestin-only pill. Combo pills contain estrogen (a hormone that prevents ovaries from popping out eggs) plus progestin (a hormone that doubles your protection by thickening vaginal mucus, making it difficult for sperm to enter the cervix). Together they remain effective for 48 hours, so you have more leeway when it comes to time. As long as you start taking one pill per day as soon as you arrive, you'll be fine. (If a full 24 hours go by and you haven't taken one, take two, then proceed as usual.) Progestin-only pills, on the other hand, remain effective for exactly 24 hours. So you must take one at the same time every day, even if that means interrupting your tour of the Museo del Prado or waking up in the middle of the night.
I want to get pregnant. Do I have to let the Pill, or any other hormonal birth control, clear out of my system?
No. You take the Pill every day for a reason: The small hormone doses disappear from your system quickly. On average, there's only a 1- to 2-week delay in ovulation after stopping the Pill, so you could be pregnant within a month. Why, then, do some docs recommend waiting a month after stopping the Pill? For logistical, not health, reasons. "If you get pregnant before you've had a period, it's harder for us to date the pregnancy," says Paula Bednarek, M.D., an ob-gyn at Oregon Health & Science University.
What's it like having an IUD put in?
First off, there are two types of IUD (intrauterine device) available in the United States. They each prevent an egg from attaching to the lining of the uterus. Mirena contains progestin as a second line of defense; ParaGard is hormone-free but contains copper, which is toxic to sperm (though not to you). Mirena works for 5 years; ParaGard is good for 10. They're inserted basically the same way. Here's the play-by-play, according to Vanessa Cullins, M.D., vice president of medical affairs at the Planned Parenthood Federation of America: Your gyno inserts a speculum and attaches an instrument called a tenaculum to the cervix to keep everything steady. Then she slides the tiny IUD through the cervix via a narrow tube. Once it's in place, the top of the T-shaped IUD pops open. Most women feel a pinch (tell your doctor if you typically find pap smears painful; she'll give you a local anesthetic) and PMS-like cramping afterward. Taking Advil or Motrin an hour before can help, Dr. Cullins says. The whole procedure lasts less than 5 minutes, and the pain usually fades within an hour.
I left my NuvaRing in the car on a 90-degree day. Will it work?
Don't count on it. Extreme temps are bad for most meds Ã¢â‚¬” the Pill included Ã¢â‚¬” and condoms, too. A spokeswoman for Organon USA, NuvaRing's manufacturer, says the rings "should be stored at 86 degrees or below." If you have a prescription plan that supplies you with 3 months' worth or more, store extras in your fridge.
Is it true that the patch falls off easily?
No. Most patch users swear this Band-Aid-like birth control, which delivers a constant stream of estrogen and progestin through your skin, withstands every_thing from triathlons to saunas. The patch comes in a three-pack: You put a new patch on each week for 3 weeks and take 1 week off. Even so, you should check it every day. On the rare occasion an edge peels up and won't firmly re-adhere, apply a new one right away.
A friend has been using a natural family-planning tool called CycleBeads for years and hasn't gotten pregnant. Does it work?
For some women. CycleBeads Ã¢â‚¬” which look like a plastic-bead necklace that's way too ugly to wear Ã¢â‚¬” were developed at Georgetown University's Institute for Reproductive Health and are based on the Standard Days Method, a statistical analysis of when most women ovulate. According to SDM, if the first day of your period is day 1, then days 8 through 19 are when an egg and sperm are most likely to hook up. The beads help you track those days by sliding a rubber ring forward one bead per day of your cycle. When the ring falls on a white bead on day 8, you know you could get pregnant Ã¢â‚¬” and therefore should use a condom if you don't want a baby (or get busy if you do). On day 20, the ring hits a brown bead, telling you that fertilization is unlikely. The good news is CycleBeads have a 95 percent effectiveness rate Ã¢â‚¬” similar to condoms. The bad news is they work only for women whose menstrual cycles are between 26 and 32 days long and who have regular periods. If you bleed 3 days one month and 5 the next, no CycleBeads for you.
Besides vasectomy and condoms, what's out there for him?
Nada. A male hormonal contraceptive is still 5 to 10 years away, experts guess. The problem is, men continuously make sperm Ã¢â‚¬” whereas women pop out only one egg per month. Also, early attempts at suppressing sperm production caused side effects like sexual dysfunction. And what guy wouldn't rather use a condom than go limp?
Are lambskin condoms as safe as latex?
No. They do prevent pregnancy but don't block STD germs, which are smaller than sperm and can pass through pores in the organic material.
I've seen conflicting info about how long it takes for fertility to return once I stop getting Depo-Provera shots. What's the deal?
On average, it takes about a year to get pregnant after going off Depo-Provera, an injectable progestin-only BC method. In fact, doctors say you could wait as long as 18 months. Why? Because Depo provides a high dose of hormones that lasts for 90 days (until the next shot) Ã¢â‚¬” which makes it appealing for women who don't want kids anytime soon and prefer a low-maintenance method of contraception. But those high doses hang around in some women longer than others. The bottom line: If you want to delay pregnancy for only a few months, don't do Depo.
I've heard women lose bone density on Depo. Should I worry about osteoporosis if I take it?
No. In Depo users, "bone mineral density is about 1 percent below normal," says Alison Edelman, M.D., assistant professor of obstetrics and gynecology at Oregon Health & Science University. "The same thing happens to women when they breastfeed," adds Carrie Cwiak, M.D., assistant professor of obstetrics and gynecology at Emory University School of Medicine. "On average, there's a decrease in estrogen in their bodies, which causes a bone loss that's completely reversible when they stop." Women on Depo don't suffer any more fractures than other women, and those bone density levels go right back to normal when they go off it.