My friend's Huff Post blog on cervical mucus has garnered 26,000 likes and 3,049 shares. Women have written from all over the world to thank her for this information. Despite our best efforts as sex educators, although we have been teaching specifics about female fertility for decades, it still seems to remains a mystery -- not only to those who want to plan a pregnancy -- but also to those who are trying to use their knowledge of fertility as a method of contraception. With the operative word being "trying".Yet, clearly Canadians are using some form of birth control, because the age of first pregnancy is continually rising. According to a report by Statistics Canada
"The switch happened in 2010 and widened in 2011, when there were 52.3 babies born per 1,000 women ages 35 to 39 and 45.7 per 1,000 women ages 20 to 24... birth rates for women in their early 40s now are nearly as high as for teens."
Young adults are trying to figure out how to succeed at work and somehow "work in" a family to their lives. The most popular methods used by young people today are male condoms, oral contraceptives and withdrawal.
But what is the best method?
There is no "one size fits all"; but there are some serious considerations, especially for women, before making a choice.
• number of partners
• current health and medical history
• how effective the method needs to be
The last point may seem odd, but a woman needs to ask herself how she would feel about being pregnant if her birth control method didn't work. Some women would accept the pregnancy; others would not. She needs to examine her feelings about abortion as well as its availability.
Methods that are 98 per cent - 99+ per cent effective:
• intra uterine system (Mirena IUS)
• combined oral contraceptives (the Pill), the Patch or the vaginal ring
• Depo Provera (depot medroxyprogesterone acetate)
• IUD (copper intrauterine device)
Effectiveness is measured in two ways: perfect use and typical use. For example,
"male condoms are an effective method. However, a man must use a condom correctly from start to finish. With perfect use, 2 women out of 100 would get pregnant (98 per cent); but with typical use, 15 would get pregnant (85 per cent)".
Withdrawal, the third most common method used by young people must also be used carefully. An inexperienced man may find that its effectiveness drops as his desire to stay inside increases.
What my friend has written about fertile mucus comes in very handy when using withdrawal or condoms. If a man does not pull out in time and his partner is at the most fertile time in her cycle, she needs to consider using emergency contraception. The same advice holds true for a condom that breaks.
What influences the method you choose?
"Ask a woman if she is using birth control and she will likely tell you whether or not she is taking 'the pill'. For most women, they are synonymous. Often, she'll ask her doctor to 'put' her on the birth control pill, which conjures the image of a five-minute consultation, prescription pad at the ready. Do the words 'informed consent' have any real meaning when it comes to birth control?"
Sadly, pharmaceutical companies skip through the loophole in Canadian laws prohibiting direct to consumer advertising in order to sell hormonal contraceptives, especially the pill. But safety is an issue. There is a difference between side effects and risks. As I point out, some hormonal methods and formulations are riskier than others.
This leaves some people wondering about alternatives.
Unfortunately, there isn't much that's new on the contraceptive scene. A few methods are in clinical trials, but nothing that really changes the birth control landscape.
But perhaps youngish women should not practice contraception too long if they want to have a baby "some day" given their decline in fertility after 35. As a young friend said to me recently, "Just assume that all my friends who are rapidly approaching 40 are trying."
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A fairly popular choice for women is the copper IUD, a small u-shaped device that inhibits sperm from inhabiting the uterus. Caroline, a mother of one, is enamoured with her IUD, which was recommended by an Ontario midwife. Although Caroline experienced some mild discomfort in the first 36 hours after insertion, she feels "like [she] can rely on it, as there is no room for me to make an error". The IUD provides a highly reliable level of protection against pregnancy. Amanda, also a parent, reports that her IUD is a "perfect fit," giving her an option that is "hormone free, removable and longer term."
Condoms, available for both men and women, are a common option for people who want more than pregnancy prevention. Now available in a variety of sizes, materials and designs, condoms, when used correctly, can offer decent pregnancy prevention without hormones, while additionally providing 80 to 95 per cent STI-related harm reduction. Another great claim for condoms is that it allows men more contraception responsibility and agency in their reproductive health.
Many people are also choosing surgery to prevent pregnancy. Nick, a father of three, states that he always knew that he would have a vasectomy. Nick is seeing "more men choose this option," despite vasectomies still being caught up in issues of masculinity. He notes that although it wasn't "super comfortable, the whole thing is over so quickly," making it a much less invasive choice when comparing it to a tubal ligation or hysterectomy.
An increasing number of women are switching to bio-based contraception, such as Fertility Awareness Method and Lactation Amenorrhea Method. Through tracking and connecting with with their cycles, women are able to control their reproduction without artificial hormones, barriers or financial cost. Of course, these natural methods aren't going to offer a guarantee on par with a vasectomy or an IUD, nor are they likely to be the best option for a sexually-active teenager. They are, however, being used by a large numbers of women to prevent pregnancy. Holly Grigg-Spall, author of Sweetening The Pill, notes that "having information about your body and your cycles is important, regardless of what you choose to use as contraception and can be a great support to other methods".
The two-thirds of women who use contraception consistently and correctly account for just 5 percent of unintended pregnancies, the Guttmacher Institute reports. On the other hand, the 19 percent of women who use birth control inconsistently account for a whopping 43 percent of all unintended pregnancies. Take the birth control pill, for example. Every year, fewer than 1 in 100 women will become pregnant if they take the pill every day, but 9 in 100 will if they don't manage to take the pill daily. Women often absorb the message that the pill is practically 100 percent effective. That's only the case if they take it precisely as directed, day-in and out.
All brands of the pill are equally effective at preventing pregnancy, but that doesn't mean they're all equally well-suited to you and your body. And for a lot of women, the onus is on them to figure out what is best."Gynecologists will prescribe the pill they have the most experience with or the one they currently have free samples of in the closet," Dr. James Simon of the Women's Health Research Center in Laurel, M.D., told Women's Health. Know the basics about what your options are. There are combination pills -- which contain both the hormone estrogen and the hormone progestin -- and progestin-only options, for women who can't take estrogen. Within those categories, there are different strengths and brands, and beyond that, there are plenty of modern, long-range options that aren't pills, like the IUD or the ring. If you're having side effects that you think might be related to your birth control, try tracking them in your calendar and taking that information with you to your next appointment with your gynecologist. It'll help your doctor or nurse get a sense of what you're experiencing and guide them toward better options for you. Some side effects may go away after your body adjusts, others may not. But you shouldn't have to settle for discomfort.
A study published last spring in the venerable New England Journal of Medicine found that intrauterine devices, or IUDs, are 20 times better at preventing unintended pregnancies than the birth control pill, patch or ring. Why? Because IUDs -- which are small t-shaped devices inserted into a woman's uterus -- eliminate human error. (For more on that, check out the previous slide.) They're currently the most effective long-acting, reversible option available -- and they are safe, despite lingering belief that they aren't.
Early versions of the birth control pill had higher doses of hormones and caused many women to gain weight, but most modern iterations do not. Numerous studies have found no link between combination pills and subsequent weight gain, although the American Congress of Obstetricians and Gynecologists points out that progestin-only pills can cause women to put on some pounds. As Time reports, there are two reasons why the birth-control-pill-weight-gain-connection endures: Girls often go on the pill when they are teenagers and may gain weight simply because they're growing up, but think it's because of the pill. Many women also go on the pill when they're in a committed relationship, and research suggests that coupled women tend to gain weight. However, as ABC reports, women can experience bloating or stomach distention when they switch or go on or off their birth control, so absolutely speak up if that's something you're experiencing.
There's a reason your doctor asks what other medications you're on before writing a prescription: Some drugs don't mix with others. And that absolutely holds true for your hormonal birth control. The list of do-not-combine-with-birth-control drugs includes, but is by no means limited to, certain antibiotics, anti-fungal medications, antidepressants and even some natural supplements, like St. John's wort, which can diminish the efficacy of birth control pills with estrogen.
As the Mayo Clinic says, healthy women who don't smoke can generally safely remain on birth control pills for as long as they'd like -- through menopause even. "Years ago it was thought that prolonged use of birth control pills would interfere with a woman's subsequent ability to conceive, but this has been shown to be false," Dr. Mary M. Gallenberg, a Mayo Clinic OBGYN explains. "Similarly, doctors used to recommend taking an occasional break from birth control pills, but this offers no benefits and may increase your risk of an unplanned pregnancy." Of course, there are permanent birth control options, like sterilization, that women and their partners can also consider if they're not having children or are done having kids.
"In the past, doctors had concerns that if you conceived immediately after stopping the pill, you had a higher risk of miscarriage. However, these concerns have proved to be largely unfounded. The hormones in birth control pills don't linger in your system," according to the Mayo Clinic. "Women don’t need to get off the pill three to six months before they’re trying to conceive, their bodies return to normal right away," Dr. Katharine O’Connell White, an OBGYN with Baystate Medical Center in Springfield, Mass., told Time. The same holds true for the IUD: ACOG says women can try to get pregnant as soon as it is removed. That said, some women may experience a gap between when they stop using contraception and when they begin ovulating. If you don't get your period within several months, you may have something referred to "post-pill amenorrhea." Talk to your health care provider.
One of the most buzzed about parts of the Affordable Care Act is the so-called contraceptive mandate, which requires that most private health insurance plans cover birth control without a co-pay or deductible. In other words, for free. There are exceptions. Certain plans have been grandfathered in, or given more time before they have to adhere to the change. Religious employers are also exempt. And while the mandate requires that the full range of FDA-approved prescription contraceptives be covered, it does not require that all brands be covered, so you might have to switch to a generic drug in order to get your contraception for free. Planned Parenthood recommends calling the member services number on the back of your insurance card to talk about what is covered by your plan.
There has been a lot of confusion about what emergency contraception is and is not. Drugs like Plan B offer a means for women to prevent pregnancy up to five days after a woman has unprotected sex (although with Plan B effectiveness decreases the longer women wait; ella, another brand, which is available by prescription only, remains equally effective within that five day window). They are not the abortion pill. Another option is to have an IUD inserted within five days of unprotected sex. The point is, even if you have unprotected sex, there are safe methods that can help prevent pregnancy if that's what you want.
Though researchers are loathe to put a date on when we can expect it, they say that both hormonal and non-hormonal birth control options for men are on the way, with research efforts supported by high-profile groups such as the Bill and Melinda Gates Foundation. Case in point, last summer scientists discovered a molecule that dramatically lowered sperm counts in mice and that could, one day, be used in humans.
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