Written by Dr. Nancy Durand, a gynaecologist at Sunnybrook with a clinical and research interest in minimally invasive surgery, HPV and colposcopy.
It's something many women can relate to: concern about an unplanned pregnancy following unprotected sex or failed birth control.
Oral emergency contraception, containing the hormone levonorgestrel -- and known in Canada as "plan B" -- is a safe option for women to prevent pregnancy. The hormonal contraception works by preventing the release of an egg and preventing implantation of a fertilized egg within 72 hours of unprotected sex. The drug won't affect an already implanted egg or an established pregnancy (it's not an abortion drug). If taken within 24 hours of unprotected sex, it is 95 per cent effective at preventing pregnancy.
Available in Canada without a prescription in the family planning area of most pharmacies, it is convenient and there are no restrictions related to age or gender, which means a friend, family member or partner can pick it up for you.
Emergency contraception tips
Go to your nearest pharmacy as soon as you can following unprotected sex. It's true that emergency contraception can be taken up to 72 hours after unprotected sex, but it is more effective the sooner you take the pill.
Expect mild side effects
In many women, nausea is the most common side-effect. Ask the pharmacist about an anti-nausea medication you can take before or with the emergency contraception. You may also experience mild abdominal pain, fatigue, headache and menstrual changes.
While most women will have a normal period the next month following emergency contraception, the hormones can change how long your period lasts and also the timing (it may come a week earlier or a week later). If your period is late, you should consider taking a pregnancy test.
Recently there have been reports about emergency contraception not being as effective for women with a body mass index (BMI) over 25. While there is some evidence to show that emergency contraception may be less effective as BMI increases, this should not discourage women of any weight from taking this safe and accessible medication. That said, it may be worth visiting your doctor or local sexual health clinic to speak about getting an IUD, which is a very effective way to prevent pregnancy in any woman.
While very effective at preventing pregnancy, emergency contraception does not protect against sexually transmitted infections, including HIV. It is wise to use condoms to reduce the transmission of STIs even if you're using hormonal birth control. If you're worried, please visit your family physician or health clinic to talk about STI testing.
Time to reflect
As emergency contraception should be approached as an occasional option for preventing pregnancy, it's a good time to think about a regular and reliable birth control strategy. Talk to your doctor -- there are many contraception options available.
If you're a parent of a teen who has recently had unprotected sex, please seize the opportunity to open the dialogue on sexuality and birth control. Teens are often more sexually active than we think, and supportive parents and your health care team can help.
Read more sexual health information for women from Sunnybrook experts at health.sunnybrook.ca
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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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