04/18/2016 03:55 EDT | Updated 04/19/2017 05:12 EDT

What You Need To Know About Birth Control

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Woman holding birth control pills, mid section

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.

• age

• 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.

What works?

Methods that are 98 per cent - 99+ per cent effective:

• sterilization

• 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.

As for men, how about a remote controlled implant or a "vasectomy switch", the Bimek SLV? Unfortunately, there doesn't seem to be anything on the scene that seems workable.

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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