Birth control pills.
Canadian women still believe some pretty outdated—or downright inaccurate!—information about the pill, patch and IUD. Our expert debunks the most common fertility-related myths.
Worried that the pill will make you fat? Heard that birth control will make you infertile? Think IUDs are off-limits until you've had kids? We talked to Toronto-based physician Dr. Christine Palmay to help us sort fact from fiction when it comes to birth control. Read on to see how she debunks these common myths, and more.
MYTH: The pill is the best contraceptive.
REALITY: Not for everyone.
When we think birth control, most of us think of the pill. But there are actually many other methods of preventing pregnancy—and while the pill may be the best choice for your friend, that doesn't mean it's the one for you. In fact, Dr. Palmay thinks for many women, the pill may not be the right option at all.
"Everyone thinks about the pill, but we have so many other options in Canada that don't require you to be tethered to a schedule where you're taking the pill at the same time every day," she says.
So what should women do? Research. Dr. Palmay says her goal is, "to make sure that patients understand how each option may or may not interfere or be compatible with their life."
So let's break it down: broadly, birth control falls into three categories, non-hormonal, hormonal and surgical. Non-hormonal contraceptives include condoms, diaphragms, sponges and copper intrauterine devices or IUDs. Hormonal contraceptives include oral contraceptives (AKA the pill, which comes in different doses), the patch, the vaginal ring (NuvaRing), shots (Depo-Provera, which has largely fallen out of favour, Dr. Palmay says, as it causes side effects like weight gain and mood fluctuations) and the intra-uterine system or IUS, a hormonal IUD. Surgical options, like vasectomies and tubal ligations, are the most effective, but they're also difficult—and expensive—to reverse.
MYTH: I don't have to take the pill at the exact same time each day.
REALITY: You really, really do.
It's not the end of the world if you slip up one day and accidentally take your birth control pill 15 minutes later than usual—but definitely do not make a habit of it.
"It's not to the minute or to the second, but an hour off one day, an hour off the next? Stack those differences over a month, and it absolutely does [matter]," says Dr. Palmay. "If you're not compliant, oral contraceptives are less effective."
MYTH: There's just one pill.
What we call the pill is actually a wide range of options. There are combined-dosage pills, which contain both estrogen and progesterone, and progesterone-only pills (though Dr. Palmay says those aren't the most pleasant pill to be on, with side effects like irregular spotting, mood changes and just feeling unwell while taking it). There are pills with higher and lower dosages—like Lolo, the lowest-dose combined oral contraceptive on the market, which was approved for use in Canada in 2014.
"We have pills that differ in the quantity of drugs per day. We have a pill that gives you a period four times a year, as opposed to every month. Some have the same amount [of hormones], some have different, and that's a discussion I have with the patients based on their cycles and their side effects," says Dr. Palmay.
MYTH: Hormonal birth control causes weight gain and other unpleasant side effects.
REALITY: While there can be side effects, in most women they're temporary.
"Officially, the answer is no," says Dr. Palmay. A 2014 review of 49 studies found hormonal birth control had "no major effect on weight."
But Dr. Palmay says some of her patients did report weight fluctuations.
"Some women experience weight gain, and in those women I just recommend a lower dose pill," she says. "But I've never had that come up enough times where it's been a concern."
It is possible that you may experience other side effects when you start using hormonal birth control; commonly reported complaints include headaches, breast tenderness and nausea. For most women though, these side effects only last for a few months (if they persist, you should talk to your doctor). On the other hand, many also report positive side effects, such as decreased acne and reduced PMS symptoms.
MYTH: It's unsafe to be on hormones.
REALITY: For most women, hormonal birth control is perfectly safe.
There are negative side effects associated with hormonal birth control—but that doesn't necessarily mean hormones are dangerous. For most women, taking hormonal birth control is perfectly safe. However, there may be an increased risk of blood clots for some women who take the combined birth control pill, or who use the patch or vaginal ring; these methods shouldn't be used by women who smoke and are over the age of 35.
And Dr. Palmay has patients who opt for non-hormonal birth control for other reasons. "I certainly have some patients who cannot be on hormones: if you have a history of migraines that are hormonally linked, if you have a history of blood clots, if you have an intense hormone-based family history of cancer. But those patients are few and far between," she says.
MYTH: If I take my pill at the same time every day, I don't have to worry about getting pregnant.
REALITY: Not neccessarily. No birth control works perfectly.
Contraceptives are not 100% effective, and that includes the pill. You may be a stickler for taking your pill at the exact same time each day, but it doesn't mean you can't get pregnant. There are many factors other than timing that affect the medication's effectiveness. One of the biggest factors? Our guts.
"I think it's archaic to get medicines through our digestive systems," says Dr. Palmay. "What happens if I eat something that interacts [with my birth control]? What if I wake up with diarrhea? You know, there are things that are out of my control that interfere with the absorption of the pill."
One form of birth control that doesn't rely on the digestive tract is the IUD.
"IUDs are much more effective, almost to the extent of tubal ligation. They are better at protecting [against] pregnancy," she says.
MYTH: Birth control is just for preventing pregnancy.
REALITY: Not true. Hormonal birth control is also a treatment for several other conditions.
Birth control doesn't just prevent unwanted pregnancies. Depending on the method, it also regulates your cycle, helps make periods lighter and less painful and can help with PMS and acne. It can even help women who struggle with iron deficiency—"they're not losing as much blood," Dr. Palmay explains. It's also a treatment for endometriosis and polycystic ovarian syndrome (PCOS).
MYTH: It's fine if I want to take a little break from hormonal birth control.
REALITY: You really shouldn't.
Maybe you ran out of medication or you forgot to reinsert your ring or put on a new patch, and you're thinking that you can just wait a month before starting up again. Turns out, that's not such a good idea. "Going on and off birth control is not recommended, and if you're considering it, speak to your health care advisor first," says Dr. Palmay. And remember, "Inconsistent use of your birth control will lead to an increased risk of pregnancy."
MYTH: Contraceptives will protect me from STIs.
REALITY: Only some of them will—and not with 100% effectiveness!
Hormonal contraceptives will not protect you from STIs. If this is something you're worried about, Dr. Palmay says barrier forms of contraceptives like condoms are your answer. But it's still possible to get an STI while using condoms, so it's important to always be cautious.
MYTH: Hormonal birth control might cause infertility.
REALITY: It definitely won't.
"A birth control pill, or any type of hormonal contraceptive, absolutely does not cause infertility," says Dr. Palmay.
Hormonal birth control regulates a user's menstrual cycle, so when a woman decides she's ready to have a baby and stops using birth control, it can take three to six months for her period to stabilize. Irregular periods during this time can cause women to panic, but the body is just taking its time to adjust.
"My biggest suggestion to women is come in three to six months before you decide to start conceiving. Come up with a game plan with your family doctor," says Dr. Palmay.
MYTH: IUDs are just for women who've already had kids.
REALITY: Women of any age can safely use an IUD.
"It used to be that doctors would say, 'Don't put in a IUD if a woman hasn't had a baby,'" Dr. Palmay says. "There was almost a sense of violating a woman or something, which is complete nonsense."
That being said, what phase of life a patient is in can affect which method she recommends—if a patient has just given birth, or really needs a "set it and forget it" method, or needs to avoid estrogen, for example. (See below!)
"The reality is, most people who are younger do pick the pill," she says. "I think it's the sense of familiarity. But I have a lot of patients that transition to the ring very quickly, and eventually an IUS. I think it's hogwash to say that certain birth controls are only suitable for women in a particular age category. You really have to look at the individual."
MYTH: I'll never need to change my birth control method.
REALITY: You might need to—and you should definitely re-evaluate your current option from time to time.
Your lifestyle now is likely very different from when you first started using birth control. Maybe you got a new job that requires you to travel. Regularly switching time zones makes it difficult to take a pill at the same time every day. Maybe you're breastfeeding and you don't want to get pregnant again. You'll have to switch to a non-hormonal or progesterone-only birth control method (Dr. Palmay says taking estrogen can interfere with breastfeeding). Or maybe you're approaching menopause and don't think you need any birth control. You actually can still get pregnant when your fertility is winding down, so Dr. Palmay discusses IUDs with her premenopausal patients.
It's important to tailor your birth control to your circumstances now. So, "when you come in and get your pap done, ask your doctor, 'What are my options for birth control?' And relook at your life," says Dr. Palmay.
Want more information about sexual health-related misconceptions? Check out these surprising facts.