Prevention & Recovery

Birth control: What works best for you?

Author: Canadian Living

Prevention & Recovery

Birth control: What works best for you?

his story was originally titled "Birth Control: What works best for you" in the August 2009 issue. Subscribe to Canadian Living today and never miss an issue!

Choice can be liberating – but sometimes knowing what to choose can be confusing. Take contraceptive methods, for example. These days we have many alternatives, from a pill to an IUS. While these advancements can improve the lives of women, the myriad options available can be daunting. Here's information to help you pick the method that's best for you.

Hormonal methods
Oral contraceptives (the pill)
A popular method of birth control, most oral contraceptives contain estrogen and a progestin. They thicken your cervical mucus so sperm can't pass through, and also thin the lining of your uterus to prevent an egg from being implanted.

Benefits and drawbacks:
The pill is 99.9 per cent effective if used as directed. It regulates your menstrual cycle, decreases cramping and can reduce acne. It must be taken daily. The pill can cause nausea, bloating, breast tenderness, weight gain and headaches, and may also increase your risk of breast cancer and blood clots.

Our expert says:
"Do not take the pill if you have a family or personal history of abnormal blood clotting, have hepatitis or mono, or have had breast or endometrial cancer," says Dr. Jerilynn Prior, scientific director at the Centre for Menstrual Cycle and Ovulation Research, and a professor of medicine in the division of endocrinology and metabolism at the University of British Columbia in Vancouver. "Don't take the pill if you have vascular migraines that are associated with auras," adds Dr. Arthur Zaltz, an obstetrician at Sunnybrook Health Sciences Centre in Toronto.

Seasonale birth control pill

You take this extended-regimen pill once a day for three months, at the end of which you have your period. It contains a progestin and estrogen, and Prior points out that since you are on this pill for more days than with other pills, you are getting more estrogen.

Benefits and drawbacks:
It's 99 per cent effective if used as directed. You will menstruate only once every three months, but you'll be more likely to have spotting or breakthrough bleeding. Potential side-effects include nausea, vomiting, weight gain, breast tenderness, difficulty wearing contact lenses and an increased risk of blood clots. It's worth noting that the Society for Menstrual Cycle Research says further study on the potential health risks and long-term safety of cycle- stopping contraception is still needed.

Our expert says:
"The main thing that women dislike is the unexpected bleeding, as opposed to a regular monthly period," says Prior. "Though there is evidence this improves within a year."

Progestin-only pill (POP)

POPs are for women who can't take estrogen for medical reasons. (Check with your doctor.) These pills work in the same manner as other monthly oral contraceptives.

Benefits and drawbacks:
POPs are 90 per cent effective if used as directed. There are no estrogen-related side-effects, but they may cause unpredictable spotting and must be taken at the same time every day, within a three-hour interval.

Our expert says: "POPs are a good choice for women who are breast-feeding," says Zaltz.

Page 1 of 4 - Find out what to do in case of an emergency on page 2
Depo-Provera injection
A doctor gives you an injection of a progestin (a higher dose than the pill) in your arm or buttocks every 12 to 13 weeks. After one year, more than 50 per cent of women stop menstruating.

Benefits and drawbacks:
It's 99.7 per cent effective and can be used by women who can't take estrogen. It may also improve symptoms of endometriosis and decrease your risk of endometrial cancer. On the other hand, it can cause irregular bleeding, weight gain and short-term bone-density loss, which is reversed when you stop the injections.

Our expert says:
"The medication is in your system for three months," says Zaltz, which is a drawback if you experience unpleasant side-effects.

Transdermal patch

You apply the patch once a week (anywhere except on your breasts), beginning on the first day of your menstrual cycle. The patch should be changed on the same day each week for three weeks, followed by one week without it. It releases estrogen and a progestin into your bloodstream.

Benefits and drawbacks:
The patch is 99.7 per cent effective if used as directed. It helps regulate your periods and curbs menstrual cramping, but it can cause irregular bleeding or spotting, breast tenderness, headaches and nausea.

Our expert says:
"The big pro is the estrogen doesn't go through your liver, as does the estrogen in oral contraceptives," says Prior.

Intrauterine system (Mirena IUS)

Mirena is a T-shaped device that is fitted and inserted into your uterus by your physician. Unlike the intrauterine contraceptive device (IUD), Mirena does not have a copper wire around it and it contains the hormone levonorgestrel, which is released slowly over time. It can be left in place and is effective for up to five years.

Benefits and drawbacks
: Mirena does not contain estrogen and is  99.99 per cent effective when it is used properly and remains in place. Although it may initially cause an increase in menstrual bleeding and cramping, after a few months it can actually reduce these symptoms. Thirty to 70 per cent of women who use an IUS stop having their periods. While rare, insertion of the IUS can puncture your uterus, requiring that the IUS be removed. The good news is this doesn't usually cause any long-term damage or concern.

Our expert says: "It's very popular, does not fall out very often, and provides a low dose of the hormone levonorgestrel that is mostly confined to your uterus," says Zaltz.

Page 2 of 4 - Nonhormonal methods on page 3!

Nonhormonal methods
Intrauterine contraceptive device (copper IUD)
A device that is fitted and inserted by a physician, the IUD has a similar T-shape to the IUS, but is wrapped in copper wire that impairs sperm's ability to swim.

Benefits and drawbacks:
There are no hormones, and it's 99 per cent effective when used properly and remains in place. Irregular bleeding or spotting can occur after it's inserted, and it can cause increased cramping and bleeding the entire time you use it. Again, perforation of the uterus may occur when the IUD is inserted, but this is rare.

Our expert says: "This method provides hormone-free, effective contraception," says Dr. Melissa Mirosh, an obstetrician and gynecologist in Lethbridge, Alta. "But unlike the IUS, which eliminates periods in 30 to 70 per cent of users, it may increase the amount of menstrual bleeding."


This latex or silicone dome, which has a flexible steel ring around the edge, must be fitted by a physician. You can put the diaphragm in your vagina up to six hours before intercourse, but don't remove it until at least eight hours after sex (the maximum wear time is 24 hours). Always use it with a spermicide.

Benefits and drawbacks:
The diaphragm is 80 to 94 per cent effective when inserted properly. It can be used by women who are breast-feeding because it does not contain hormones. The catch is that it increases your risk of developing a urinary tract infection.

Our expert says:
"It's a good fit for women who want a nonhormonal method of birth control," says Mirosh.

This latex shield fits over an erect penis. Read the directions on the package for putting on and removing a condom, because using it properly is key to making sure it's effective.

Benefits and drawbacks:
A condom is 97 per cent effective when used properly and protects against many sexually transmitted infections (STIs) but not human papillomavirus or hepatitis B. The drawbacks are that a condom may reduce sensitivity for either partner, or even slip or break during sex. People with latex allergies may be able to use condoms that are made out of polyurethane, silicone or lambskin.

Our experts say:
"If a young woman is sexually active, the best option for her is to use a low-dose birth control pill and a condom every time [she has sex]," says Stephanie Mitelman, a certified sexuality educator in Montreal. However, Prior says young women should also carefully consider nonhormonal options before taking the pill.

Female condom

This polyurethane sheath, in the shape of a round, upside-down Baggie, is put into your vagina before sex. (Insert an applicator of contraceptive foam or jelly into your vagina before putting the female condom into place.) One ring anchors the condom inside (like a diaphragm) and the other, external ring The only contraceptives that will protect you against sexually transmitted infections are the male and female condoms. holds it in place. You can insert it up to eight hours before intercourse.

Benefits and drawbacks: There are no hormones, and it's 95 per cent effective when used properly and with contraceptive foam or jelly. However, some women have trouble inserting it correctly. Some users also say that it's noisy during sex.

Our expert says:
"The female condom will not disrupt your menstrual cycle or cause a risk for future osteoporosis and bone fractures as do oral contraceptives," says Prior. "It also protects against the ever-present risk of STIs."

Page 3 of 4 - Read about why withdrawal doesn't work on page 4

Cervical cap
This silicone cap fits against your cervix. Spermicide is applied inside the cap before it's inserted.

Benefits and drawbacks:
There are no hormones, and like the diaphragm and female condom, you can insert the cap before sex, which gives you privacy and control over your contraception. That said, a poor fit or a silicone allergy prevents some women from using the cap. And it's typically only 60 to 80 per cent effective.

Our expert says: "Like a diaphragm, a cap needs to be properly �tted by your doctor," says Mirosh.

Contraceptive sponge

The sponge is a soft polyurethane foam device �lled with spermicide that you place deep in your vagina before sex. It's effective for up to 12 hours. You must leave the disposable sponge in for at least six hours after the last time you have sex, and for no longer than 30 hours in total.

Benefits and drawbacks: The sponge does not require �tting or insertion by a doctor, and does not have hormones. On the downside, it increases your risk of yeast or other vaginal infections, as well as irritation of your vulva and vagina, and your partner's penis. It's only about 60 to 80 per cent effective.

Our expert says:
"The sponge may be chosen by women who want or need to avoid hormonal contraception," says Mirosh. "However, they must be aware of the high failure rates."


Spermicides include creams, jellies, suppositories, gels and �lms that you use with another form of contraception, such as a condom or diaphragm.

Benefits and drawbacks:
They do not contain hormones, and can be used by women who are breast-feeding, but they are only 79 per cent effective when used alone. As well, some people are allergic to spermicides.

Our expert says:
"This method is under your control, won't disrupt your cycle and does not have a negative effect on your bone health," says Prior.

For more information on hormonal contraception, visit the Centre for Menstruation Cycle and Ovulation Research's website at; the Society for Menstrual Cycle Research at www.menstruation; the Canadian Federation for Sexual Health at; and

Withdrawal: Timing isn't everything
Men cannot always control when they are going to ejaculate, and even before they do, they release pre-ejaculate, which also has sperm in it. This is why withdrawal isn't an effective birth control method.

Surgical Options
• For women, tubal ligation and tubal implants often require hospitalization and general anesthesia.
• For men, vasectomies (which block or cut the male sperm duct to prevent sperm from entering ejaculate) carry fewer risks and can be performed in a doctor's office in about an hour.
• Both procedures have a less than one per cent failure rate and are considered permanent, since reversal is difficult, costly and not guaranteed, especially for women. But neither protects against sexually transmitted infections.

In an emergency…
Here are three ways to prevent pregnancy after unprotected sex:
A single dose of a contraceptive pill called plan B.
2. A series of two doses of contraceptive pills, called the Yuzpe method.
3. The insertion of an iUD. Up to 99 per cent of women who use one avoid an unwanted pregnancy.
Emergency contraceptives can be obtained from your doctor, at a walk-in clinic or directly from your pharmacist.

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Prevention & Recovery

Birth control: What works best for you?