Birth control: The modern woman's guide

The pill is no longer the only birth control women use. From IUDs to withdrawal, we have the latest info on your contraception options. 

By Jill Buchner

Birth control: The modern woman's guide
©iStockphoto.com/fotum
Eight years ago, Andrea Green* made a life-changing decision: She gave up her monthly pack of birth control pills for a hormonal intrauterine device (IUD). Though she had been on the pill since she was 16, she had recurring migraines that, combined with her age (34), put her at an increased risk of stroke.

"I was at a point in my life where I decided I didn't want to have kids," says Andrea. She did her research and found that the Mirena, a hormonal IUD that prevents pregnancy by slowly releasing a progestin-type hormone into the uterus, was 99 percent effective, could last five years and would be less expensive than the pill long-term.

"It's the best thing I've ever done for my sexual health," says Andrea, who is now on her second hormonal IUD and hasn't had a period in eight years. "It's worry-free. I never think about birth control, and I did all the time when I was on the pill." Now she tells all her friends to try the IUD. "I sometimes joke that I should walk around with a T-shirt that says: 'Ask me about my Mirena.'"

How to find birth control that suits your lifestyle
Andrea is not alone. Women all over Canada are discovering birth control options that better suit their lifestyles—options that weren't available a decade ago. They're doing the research and they're spreading the word to their friends.

"We are talking about all the contraceptive choices now, whereas before we didn't have a lot of education, or if we did, it often defaulted to the pill," says Jennifer Gibson, coordinator of community education services at Island Sexual Health in Victoria. The changes may not mean a '60s-scale sexual revolution, but they are offering women newfound freedom. "We're empowering women to listen to their bodies and to realize that they are the experts on their own experiences," says Gibson.

For a long time, the term "birth control" was synonymous with the pill. Since it was introduced in the '60s, the pill has consistently been a leading contraceptive among Canadian women. But today's pill is not your mother's pill. New lower-dose formulations make for fewer uncomfortable (and even dangerous) side-effects.

Meanwhile, the demands of modern life have given rise to new, more convenient methods of getting similar hormones. "When you look at our lives in 2014, with all our demands, it's really hard to do something at the same time every day," says Gibson, citing crazy schedules and travel across time zones as some of the big reasons women find the pill a challenge. The solution? Birth control patches that are applied weekly, or vaginal rings that you change once a month. And for those who just need a reminder to take the pill, there are apps to prompt you every day.

But hormonal contraceptives aren't for everyone. Many women experience side-effects such as spotting, mood swings or decreased sex drive on the pill. "Some women are on hormones and they never felt good on them. Maybe they always had bloating or always had nausea when they took their pill. And when they go off, they feel more normal," says Dr. Erika Feuerstein, MD, medical director at the Bay Centre for Birth Control at Women's College Hospital in Toronto. Some of those women might opt for an IUD.

IUDs: What you need to know
"IUDs are exploding right now," says Dr. Feuerstein. "We can't get people into the clinic fast enough." IUDs may have had a shady history in North America, but they're back with a vengeance. In the '70s, when a particular IUD called the Dalkon Shield hit the market, it brought some alarming complications, one of which was increasing women's risk of pelvic inflammatory disease. The Dalkon Shield was associated with infection, infertility and even death.

After that, IUDs fell out of favour in Canada for decades. Doctors were afraid to recommend them and women were afraid to try them. But the Dalkon was just one design. And in recent years, both copper IUDs and the hormonal variety (which releases a progestin-type hormone into the uterus, protecting from pregnancy for up to five years) have been booming.

The hormonal IUD may have the effect of lightening periods or even stopping them altogether. And both options offer long-term solutions for the growing number of women who want to remain childless or delay pregnancy until later in life. (If you choose to get pregnant, you can have an IUD removed at any time.) Though the insertion can be a little, ahem, uncomfortable—it has to go through the cervix to get to the uterus (ouch!)—it's a little pain for a lot of gain. "People want to switch to something that they don't have to think about using every day or week or month," says Gibson.

The copper IUD may not have the menstruation-mitigating benefits, but it has its share of fans, too. "In Victoria, we do a lot of copper, and it may be that people feel it's more natural," says Gibson. The copper IUD doesn't contain hormones, so it's a great option for those who suffer from side-effects or for those who are just uncomfortable with putting chemicals in their body.

"We also have people coming in with environmental concerns," says Gibson. Some women are becoming aware of the impact of introducing estrogen into the water supply or sending contraceptive waste to the landfill every week or month. With some copper IUDs lasting up to 10 years, they are about as low-impact as you can get.

All natural birth control
Then there are the women who have given up on all of these methods. For various reasons—health, lifestyle, environmental—a small subset of Canadians is going au naturel. A recent study published in the Journal of Obstetrics and Gynaecology Canada found that 12 percent of 20-something women and 10 percent of 30-something women who used contraception had used withdrawal as a method of birth control over a six-month period.

The trend of using withdrawal, often combined with the rhythm method, has lead the current generation to be labelled "the pullout generation." Though pulling out might be a viable option for those in committed, trusting relationships, experts agree it's not a method for those who are serious about avoiding pregnancy. And while new apps based on the rhythm method claim to help couples better plan their lovin', Dr. Feuerstein warns that no app can measure the physiological signals for ovulation; all they can do is track the calendar. Furthermore, even the most regular of cycles can be thrown off by stress, illness or travel.

Luckily, the biggest trend in birth control right now is education. Experts agree that access to information has improved enormously—largely thanks to the Internet. "That's how I got all the information about my Mirena," says Andrea. "It's where I learned about other women's experiences. I wouldn't have had that 20 years ago." Gibson says women coming into her clinic are much better informed than before, and they know all the right questions to ask. "In 2014, we have such dynamic lives," she says. "The choices we have now can help fit that dynamism. And we have the ability to access education and make choices that work for us."

3 myths about birth control pills:
1. They affect your fertility even after you go off them
Maybe you've heard a friend complain she was on the pill for 15 years and now can't get pregnant. The problem isn't the birth control; it's that she's 15 years older. "The eggs are still aging when they're on the pill," explains Dr. Feuerstein.
 
2. They're 99.9 percent effective
This may be true in theory, but in practice it's almost never so. That stat is based on perfect use, meaning you take the pill at the exact same time every day, without any mitigating circumstances (such as vomiting or antibiotic use).

3. They cause cancer
While certain breast cancers are estrogen sensitive and some are progesterone sensitive, there is conflicting data about whether hormonal contraception can increase the risk of breast cancer, says Dr. Feuerstein.

Meanwhile, there are potential health benefits. Women who have the BRCA1 or BRCA2 genes (mutations of which are linked to breast and ovarian cancers) might be put on the pill for a few years when they're young, because the estrogen is known to protect against ovarian cancer. Still, long-term oral contraception wouldn't be recommended for BRCA patients or others at high risk of breast cancer; estrogen might not cause breast cancer, but it could stimulate existing cancer cells, even before you know they're there.

Is your birth control safe?
This past year, the media has been abuzz with concerns about birth control pills. Two of Canada's most popular brands, Yaz and Yasmin, are subjects of class action suits after a number of users experienced strokes, blood clots and other adverse reactions, some resulting in death. Blood clots have long been associated with the pill, but some formulas may carry a higher risk than others. Neither brand of pill has been recalled, so you can decide for yourself whether to use them.

The good news is that many women are now thinking more carefully about their own birth control. "If a certain pill is talked about in the media, anyone who's on that pill starts asking questions," says Dr. Feuerstein. Gibson says that her clinic takes those questions as an opportunity to discuss and reassess a woman's birth control choices. "We look at the method they're choosing to make sure it offers the least amount of risk with the most amount of benefit." Talk to your doctor to ensure that other factors (such as smoking, migraines or a history of blood clots) don't put you at higher risk.

*Name has been changed.

For more information on contraception, check out 5 reasons why IUDs are making a comeback.

This content is vetted by medical experts

                                               
This story was originally titled "The Guide To Down Under" in the May 2014 issue.
           
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