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Birth Control Q&A

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I heard IUDs can cause infertility. Is that true?

It’s a common myth, but it’s not true. IUDs — intrauterine devices, increasingly referred to as IUCs (intrauterine contraceptives) — are among the safest, most effective, and least expensive methods of birth control available. In fact, they are the most popular form of reversible birth control in the world. More than 85 million women use IUDs. 

The myth started in the 1980s. An insufficiently tested, defective brand of IUD — the Dalkon Shield — had to be removed from the market because of the damage it caused, including infections that led to infertility. Today’s IUDs are safe, effective, and do not cause infertility. 

Sexually transmitted infections (STIs) cause infertility, not IUDs. If you have an IUD inserted while you have an STI, you increase your chance of infertility. That’s why most health care providers test for STIs before inserting IUDs. 

IUDs do not protect against STIs. That’s why women who use methods such as IUDs, hormones, diaphragms, sponges, or cervical caps need to protect themselves with condoms whenever there’s a risk of infection.

Do I need a pelvic exam to get the pill, patch, shot, or ring?

It all depends on your medical history. For many women, the pelvic exam will be optional. In some cases, a physical exam is needed before a prescription can be given. The health care provider will help decide what is best for each woman by discussing her medical history with her.

Whether or not it is optional for you, we know that all sexually active women need to have periodic gynecological visits, including a Pap test. Pap tests can detect precancerous cell growth in the cervix. These early warnings save thousands of women's lives every year. They can save yours. We know that millions of women and men carry the virus that causes cervical cancer. So when it comes to preventing cervical cancer, nothing is more important than Pap tests. Your Pap test results will help your clinician decide how often you should have your periodic visits and exams.

How old do you have to be to get your tubes tied?

Policies and practices vary with individual providers and hospitals, and from place to place. The federal government, for example, will not fund sterilizations for anyone under 21. It even requires a 30-day waiting period for women who are older. Under some circumstances — if a woman is young, single, or childless — it may be hard to get a tubal sterilization.

Sterilization should be considered permanent and irreversible. Here are some of the reasons against considering sterilization that may be especially true for some younger women:

  • You may want to have a child in the future.
  • Your partner, friends, or family may be pressuring you. But it is you who must want the operation. You may want to involve others for advice or opinions, but the decision is ultimately yours.
  • You may have problems that may be temporary — marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work. Sterilization should not be considered a solution for life's problems.
  • You may not have considered possible changes in your life, such as divorce, remarriage, or death of children.

Today's young woman has a wide range of options for safe, effective, long-term reversible contraception. Sterilization may be a better option only in certain cases.

Are there any herbal contraceptives that work?

No, at least not well enough to count on. And some also have toxic side effects. That's why Planned Parenthood recommends only FDA-tested and approved methods of contraception.

Until the advent of medically safe, effective contraception in the 20th century, millions of women worldwide relied on a wide variety of herbal treatments for contraception before and after intercourse. One of the most effective — an herb called silphium — was so popular that it sold for its weight in gold all over the ancient world. After being used for more than a thousand years, it was over-harvested and became extinct in the 4th century.

It's interesting that many medieval recipes for herbal contraceptives and abortifacients were published by Peter of Spain, who became Pope John XXI in 1276. Modern lab tests show that the pope's recipes were quite effective for their day, but their side effects were often disastrous.

Isn't it true that kids are more likely to have sex if their schools distribute condoms?

No, it isn't true. Many studies have proved the opposite. The latest was recently published three year ago in The American Journal of Public Health. It showed that kids in schools that distributed condoms were less likely to have sexual intercourse than kids at schools that don't distribute condoms.

The study also suggests that kids in high schools with condom programs were more likely to use condoms. Young people in other high schools were more likely to use other kinds of birth control. But only latex and female condoms reduce the risk of sexually transmitted infections. The fact is that kids in schools that distribute condoms are less likely to have sexual intercourse and are less likely to get a sexually transmitted infection.

What would be wrong with making teens ask their parents for permission to use birth control?

Basically, it would lead to more teen pregnancy. Minors seeking sexual health care services at a Planned Parenthood health center in Wisconsin were asked what they would do if they had to tell their parents they were using contraceptives. Nearly half said they would stop going to the clinic. Many others said they would stop using any sexual health care service. But only one percent said they would stop having sexual intercourse.

Unfortunately, not all young people can trust their parents to be helpful. Some parents are abusive. Many young people don't even have contact with their parents. To keep kids safe and healthy, most states wisely let young people consent to their own medical care for a variety of services. These critical services include counseling, testing, as well as care for mental health problems, drug and/or alcohol addiction, sexually transmitted infections, and pregnancy. Planned Parenthood believes that confidential health care is a public health necessity — for the young as well as for adults.

Is it safe to take the pill continuously to avoid having periods?

Yes, it is — except for women who should not take the pill at all. Likewise, it is safe to continuously use some other hormonal methods, like Depo-Provera injections, the Mirena IUD, or the vaginal ring to supress menstruation.

Up to 44 percent of U.S. women would rather not menstruate. Many use hormonal contraception to control their cycles for various reasons — to plan a honeymoon or athletic event, to alleviate medical conditions such as endometriosis, to avoid discomforts like PMS, for convenience, or simply because they don't like menstruating.

Women in prehistoric times spent more time pregnant than modern women. They only had about 160 periods in a lifetime. Modern women have about 460. Some researchers believe that reduced ovulation and menstruation among today's women may protect against cancers of the reproductive organs.

Is there really a new kind of permanent birth control for men that isn't a vasectomy?

Yes, there is — sort of. In a vasectomy, each tube that carries sperm — vas deferens — is cut, tied off, cauterized, or blocked. This prevents sperm from being ejaculated during orgasm and causing pregnancy. The new method of keeping sperm from being ejaculated is called a Pro-Vas® clip. With this method, the tubes are not cut, sutured, or burned. They are clamped shut.

To put a Pro-Vas clip in place, however, an incision or puncture of the scrotal sac is needed, just as in a vasectomy. But because the tubes aren't cut, the risk of certain complications may be reduced.

I heard it's dangerous to take the Pill for more than 10 years. Is that true? Is there a limit?

No, it's not true, and there is no limit to how long a woman can take the pill. Millions of women around the world have taken the pill since the FDA approved it in 1960. It has been the most scrupulously tested medication of our time.

Countless women take the pill from adolescence through perimenopause. Many stopped taking the pill only when they wanted to become pregnant and started taking it again after giving birth. Women not only rely on it for contraception but for menstrual regularity and other benefits. These benefits include

  • less menstrual flow and cramping
  • less infection of the fallopian tubes (pelvic inflammatory disease), which often leads to infertility
  • fewer ectopic pregnancies (those in a fallopian tube)
  • fewer noncancerous breast growths
  • fewer ovarian cysts
  • reduced risk of cancer of the lining of the uterus and of the ovaries
  • less iron-deficiency anemia that results from heavy menses
  • less acne
  • fewer premenstrual symptoms, as well as related headaches and depression
  • protection against osteoporosis — loss of bone mass
  • less excess body hair
  • less vaginal dryness and painful intercourse associated with menopause

The fact is that over the long term, use of the pill has offered many health benefits to millions of women worldwide.

Should a guy wear a condom when receiving oral sex? Does it prevent any diseases?

Using condoms or other barriers can reduce the risk of infection for both partners. The infections most commonly transmitted by oral sex are gonorrhea, herpes, hepatitis, and syphilis.

Safer sex, including condom use, is anything we do to lower our risk of getting a sexually transmitted infection. It's about getting more pleasure with less risk. The risks from oral sex are generally lower than the risks from vaginal or anal intercourse. Using condoms or other barriers can further reduce those risks.

I heard somewhere that sterilization is the most popular form of birth control in the U.S. Can that be true?

Yes, it's true. About 27 percent of all women who use contraception rely on tubal sterilization. Nearly 10 percent rely on their partner's vasectomy. In all, about 37 percent of all women who use contraception rely on methods that are intended to be permanent.

The most popular reversible contraceptive in the U.S. is the Pill. (Worldwide, it's the IUD.) More than 30 percent of women who use contraception use the Pill. About 18 percent rely on the condom. More than five percent rely on hormone injections. Another four percent rely on withdrawal. All other methods combined — diaphragms and caps, periodic abstinence, implants, IUDs, female condom, and spermicide — are used by about six percent of women who use contraception.

I had a tubal six years ago after my second son was born. Since then I've had maybe one period a year. Do tubals cause early menopause?

No. Tubal sterilization blocks the fallopian tubes. This prevents sperm from joining with an egg. The ovaries and the uterus remain intact and unchanged after tubal sterilization. This means that a woman will continue to produce the hormones that influence her menstrual cycle. And she will continue to have her period.

The average age for menopause is 51. If natural or induced menopause is reached before the age of 40, it is called ovarian failure or premature menopause. Be sure to consult your health care provider if you have questions about unusual vaginal bleeding or menstrual irregularity.

How soon will it be before there's a pill for men?

There are still years to go, although there seem to be breakthroughs in the research every once in a while. Finding a safe and effective way to keep a man from producing millions of sperm a day has proven to be more difficult than it is to keep a woman from producing one egg a month.

However long it takes, it will be worthwhile. Men are very willing to take responsibility for birth control, even though there are comparatively few options for them. In fact, men now take responsibility for more than a third of all contraception. More than 20 percent of all couples who use contraception rely on the condom. Nearly 11 percent rely on vasectomy. Three percent rely on withdrawal. And more than two percent rely on periodic abstinence.

Can't HIV pass through condoms? Why use them if they don't even work to prevent sexually transmitted infections?

Don't listen to the nonsense some people are spreading about condoms. The virus is embedded in blood, semen, or vaginal fluids, none of which can get through an intact condom. Condoms offer the best protection against sexually transmitted infections for sexually active people and they protect against unintended pregnancy.

Latex condoms offer very good protection against HIV. In fact, the risk of HIV transmission with a condom is reduced as much as 10,000 times. They also reduce the risk of other sexually transmitted infections, including chlamydia, gonorrhea, herpes, HPV (human papilloma virus), PID (pelvic inflammatory disease), syphilis, and trichomoniasis.

Will flu shots interfere with my birth control?

No. Flu shots will not decrease the effectiveness of hormonal birth control methods.

The only medications that will reduce the effectiveness of combined hormone methods like the pill are the anti-tuberculosis drug, rifampin (Rifadin) and anticonvulsants/anti-seizure medications such as Tegretol, Dilantin, Mysoline, phenobarbital and the anti-fungal medication griseofulvin.

I'm allergic to latex! What can I use instead of latex condoms?

There are two alternatives to latex condoms for people who are concerned about reducing the risk of sexually transmitted infections and unintended pregnancy. Female condoms are made of polyurethane. When used correctly and consistently, they're up to 95 percent effective against pregnancy, and they also reduce the risk of infection. Currently, the only brand on the market is FC Female Condom.

Polyurethane male condoms are also available. Avanti and Trojan Supra are brands of polyurethane male condoms. Polyurethane condoms (both female and male) are usually more expensive than latex condoms, but they can be used with both oil — and water-based lubricants or medications.

Is it true that emergency contraception causes abortion? What about other hormonal methods of birth control?

No. Abortion ends a pregnancy. Emergency contraception (EC) cannot end a pregnancy. EC works before a pregnancy begins. Pregnancy begins with the implantation of the developing fertilized egg in a woman's uterus.

EC can be started within five days of unprotected intercourse. It prevents ovulation — the release of the egg. Or it prevents fertilization — the joining of the sperm and the egg — which usually occurs within six days of intercourse. In theory, it's possible for EC to prevent implantation, but implantation doesn't occur until five to seven days after fertilization.

The same is true for the pill, the shot, the patch, and the ring. They also prevent ovulation and fertilization, but not implantation. It is very unlikely that an egg would be released or fertilized while a woman is using them.

My insurance doesn't cover my birth control, but my friend's insurance does. How is that fair?

It's not fair! Nearly half of all pregnancies in the U.S. are unintended, and more than half of all unintended pregnancies end in abortion. Yet fewer than half of all states require insurance companies to cover birth control. In states where insurance coverage is not mandatory, the decision to provide coverage is left up to individual businesses or insurance plans.

Not covering birth control is unfair, especially when drugs such as Viagra® are covered. Contraception is a basic health care need — it's used by 98 percent of women who have had vaginal intercourse at some point in their lifetimes.

Planned Parenthood is committed to ensuring that insurance companies cover contraception.

Do women who take the pill need to use another kind of protection during menstruation when they are taking the non-active, reminder pills?

No, another contraceptive method is not needed to prevent pregnancy. Combined hormone birth control pills work primarily by preventing ovulation — the release of the egg from the ovary. If the pill is taken daily as prescribed, eggs will not usually be released. Pills also work by thickening the cervical mucus. In the rare instance that an egg is released, the thick cervical mucus will prevent sperm from entering the uterus. An egg can only live up to 24 hours. In the very unlikely event that the egg is released on the day the last active pill is taken (Day 21), the cervical mucus will prevent fertilization.

The effect of hormones taken during the 21 active pill days continues while the non-active reminder pills are taken. This means that fertilization does not take place at any time during the 28-day cycle in which the pills are taken — even during the time that reminder pills are taken and menstruation occurs.

Do low-carbohydrate diets, like the Atkins diet, interfere with the effectiveness of the pill or increase menstrual flow and breakthrough bleeding?

No. There is no evidence that dieting has an impact on the effectiveness of the pill or on the increase of menstrual flow or breakthrough bleeding in women who take it.

It has been shown that severe dieting, such as that associated with anorexia and bulimia, can cause amenorrhea — the absence of menstruation. But we know of no diets that have been scientifically shown to increase menstruation or breakthrough bleeding.

Does taking antibiotics make the pill less effective?

Only one antibiotic is known to make the pill less effective. That is rifampin, a special medication used to treat tuberculosis. The brand names include Rifadin and Rimactane. Other antibiotics do not make the pill less effective.

Certain other medicines may make the pill less effective. These include

  • certain anti-HIV protease inhibitors
  • certain anti-seizure medications
  • a particular anti-fungal medication, griseofulvin (Fulvicin, Gris-PEG, Grifulvin V, Grisactin, and Gristatin), which is used to treat severe, often life-threatening fungal infections

It is always wise to know how other medications may interact with the pill. Some medications may be less effective when used with the pill. These include

  • analgesics — for example, acetaminophen (Pamprin, Tylenol, Parcetamol, aspirin-free Excedrin, and others)
  • antihypertensives — for example, cyclopenthiazide (Prothiazide)

The effects of some medications may be exaggerated when used with the pill. These include

  • antidepressants — for example, imipramine (Janimine and Tofranil)
  • bronchodilators — for example, theophyline (Primatene, Theo-Dur, Marax, Bronkotabs, Quibron Tedra, and others)
  • tranquilizers — for example, benzodiazepam (Valium, Ativan, Librium, Serax, Tranxene, Xanax, and others)

Is it true that condoms cause HPV infections that lead to cancer?

Absolutely not. This is one of the myths that comes from anti-family planning misinformation campaigns. Latex condoms or female condoms are the best way for sex partners to reduce the risk of infection during intercourse, including the kinds of HPVs (human papilloma viruses) that cause cancers of the cervix and penis.

Condoms not only reduce the risk of infection, they are also helpful in reducing the effects of existing HPV infections. Recent studies from the Netherlands show that condom use leads to a faster disappearance of changes caused by HPV in the skin of the penis or in the cervix.

Is it safe to use a condom in the shower?

Yes. Latex condoms can be used safely and effectively in the shower or in the pool. Water does not affect the strength of the latex. But do not use oil-based lubricant or bath or shower lotions with the condom because they can deteriorate it. Also, be careful about using soap for lubrication. The oils in the soap will weaken the condom, too. And the caustic nature of most soap, combined with the friction of sexual activity, can cause tears and cuts in the skin of the genitals, which will increase the risk of infection.

I've been hearing lately that the birth control patch is dangerous. Is that true?

No. Millions of American women have safely used Ortho Evra — the patch — since it was introduced in 2002. When used correctly, the patch is up to 99.7 percent effective against pregnancy.

Despite the proven safety of the patch, stories about "adverse events" for women who are using the patch have appeared in the press. "Adverse events" are those that may happen during the use of medication but are not necessarily caused by the medication — anything from allergic reactions to very serious effects. While all medications are associated with adverse events, medical authorities and health officials have yet to find evidence proving a causal relationship between recently reported adverse events and use of the patch.

A recently published study demonstrated that a small sample of women — 24 — had a somewhat greater exposure to hormones during a 21-day treatment cycle than women using other low-dose methods — the ring and the pill. This finding is now reflected in labeling for the patch. The study did not find an increase in adverse events among patch users.

There are, of course, potential side effects and risks associated with all medications. This is also true of combined hormone methods of birth control, such as the patch, the pill, or the ring. That is why most health care providers will not prescribe them to women who have medical histories that increase the possibility of those risks. The patch, the pill, and the ring, are not suggested for women who are 35 years old or older and who smoke or who are otherwise at increased risk of heart attack and stroke.

The patch is increasingly popular with women for a reason — it is one of the safest, most convenient, and most effective methods of reversible contraception available to women today.

Does the pill cause birth defects when a woman stops using them?

No. The birth control pill has been on the market for more than 40 years. It has been under constant scientific scrutiny and is one of the most carefully studied medications ever used.

There is no evidence that the pill puts women at risk of having a child with birth defects — either while she is using it or after she stops using it. Birth defects do, however, increase with increasing maternal age, so women who are planning to have children later in life may want to consider preconception planning to evaluate their risks.

Does using the pill really help cure acne?

Yes. Less acne is one of the many non-contraceptive advantages to using combined hormone methods of birth control — the pill, the patch, and the ring. The other non-contraceptive advantages include

  • less menstrual flow and cramping
  • fewer ectopic pregnancies (those in a fallopian tube)
  • fewer noncancerous breast growths
  • fewer ovarian cysts
  • reduced risk of cancer of the lining of the uterus and of the ovaries
  • less iron deficiency anemia that results from heavy menses
  • fewer premenstrual symptoms, as well as related headaches and depression
  • protection against osteoporosis — loss of bone mass
  • less chance of infection of the fallopian tubes (pelvic inflammatory disease), which often leads to infertility
  • less excess body hair
  • less vaginal dryness and painful intercourse associated with menopause

In fact, as many as one third of the prescriptions written for the pill are not written for birth control; they are written for the non-contraceptive benefits.

Can a woman use the pill if she has high blood pressure?

Combined hormone methods of birth control — the pill, the patch, and the ring — should not be used by women who have confirmed and untreated blood pressure over 140 systolic or 90 diastolic.

Women who request prescriptions for combined hormone methods must have their blood pressure checked. If they have somewhat elevated blood pressure, they may be asked to have their blood pressure checked again between three to six months after they first receive their prescriptions. Women who renew their prescriptions after a year of use will also have their blood pressure checked, to make sure their methods are still right for them.

 Is it true that the pill protects against heart disease?

No. The combined hormone pill has many non-contraceptive advantages, including protection against acne, cancers of the lining of the uterus and ovaries, ectopic pregnancy, excessive body hair, iron deficiency anemia due to heavy menstrual periods, PMS, and vaginal dryness and painful intercourse related to perimenopause and menopause. But it does not protect against heart disease. Although a recent study caused a bit of a media stir by claiming that the pill also had this advantage, that study was very flawed, and its claims were unfounded.

Although using the pill is much safer for women than pregnancy and childbirth, combination pill users have a slightly greater chance than nonusers of developing certain major disorders, including blood clots and liver tumors Their risk is increased by being age 35 or older, smoking, and by having conditions associated with heart attack. That is why women with medical histories that include blood clots, heart attack, stroke, uncontrolled high blood pressure, or vein inflammation should not take the pill or use other combined hormone methods — especially if they smoke. Women who have not had a heart attack but who are at high risk for heart disease may use the pill — but only under close medical supervision.

Most healthy women can take the pill and enjoy its highly effective contraceptive and non-contraceptive advantages. That's why it is the most popular prescription method of reversible birth control in the United States.

What are low-dose birth control pills? If they're effective, why doesn't everyone take them?

Low-dose birth control pills are safe and effective hormonal methods of birth control. Most pills combine estrogen and progestin. Some are progestin-only. Both hormones can cause uncomfortable side effects for some women — everything from the blues, bloating, and breast tenderness to irregular bleeding and vomiting. These discomforts are not dangerous and usually go away in three months.

When scientists first invented the pill, they wanted to be very sure it worked. It turns out that they used more hormone than most women need — up to 1,000 times more!

Since then, the FDA has approved many different brands of low-dose pills. Each has slightly different levels of hormones. Most women do well with any of them and shouldn't have significant side effects after the first three months. A small number of women may have a side effect that won't go away. Their health care providers can identify certain brands that may relieve particular discomforts.

I am a 30-year-old woman who had my tubes tied. Now I need to see if I can get a reversal. Does Planned Parenthood help with the reversal? Can you tell me if there is a place I can go that may help me with my situation?

Reconnecting the tubes after tubal sterilization requires complicated surgery and it is costly. Even if the tubes are reconnected, pregnancy cannot be guaranteed. Reproductive endocrinologists perform these procedures. They are obstetrician gynecologists with special training in infertility. The procedure is called an "anastomosis" — the joining of two tubes.

The doctor will evaluate you to ensure that you are a good candidate for the procedure. You will be examined to be sure that there are no other causes than blocked tubes to prevent you from becoming pregnant. An evaluation will also be made to determine how much tube was removed. This can be done by checking the report from your sterilization procedure, using x-ray dye studies, and with diagnostic laparoscopy — a surgical procedure in which the fallopian tubes are viewed by using a light and viewing lens on a tube that is inserted through a small incision made in your navel. Depending on how much tube is left, the doctor may advise in vitro fertilization as your best option for pregnancy.

Some Planned Parenthood affiliates have referral networks that include infertility specialists. If you have insurance, contact your health plan for referral to an infertility specialist. If you don't have insurance, contact the ob/gyn department of your nearest academic medical school hospital to find a reproductive endocrinologist.

Women who have tubal sterilizations before they are 30 are more likely to regret it than women who are older. Overall, more than 14 percent of women who have had tubal sterilizations request reversals, but only about one percent obtain them. Some women elect in vitro fertilization instead of attempting reversal. Others turn to adoption when they discover they want children after tubal sterilization.

Sterilization — for women and men — is the one of the most popular methods of contraception worldwide.  Sterilization is not easily reversed because it is meant to be permanent.

I am 24 years old, have had two strokes, and can't take the pill. I have been on the shot for more than a year, but don't like it. What are my other options besides abstinence and condoms. I heard that said that the pill actually decreased your chance of stroke. Is this true?

No, it is not true. Combined hormone contraceptives, such as the pill, patch, or ring, can increase the risk of stroke. The increase in risk is very small for healthy women. The risk becomes much larger for women like you who are at much greater risk for stroke than the average woman. You, and other women with medical histories that include blood clots, heart attack, stroke, uncontrolled high blood pressure, or vein inflammation, should not take the pill or use other combined hormone methods such as the patch or ring — especially if they smoke. Although a recent study caused a bit of a media stir by claiming that the pill reduced the risk of heart attack and stroke, that study was very flawed, and its claims were unfounded.

Women who cannot take the pill or other combined hormone methods — the ring or the patch — do have other alternatives besides abstinence, condoms, and the shot. These include IUDs, diaphragms, Lea's Shield, and FemCap. Depending on your personal medical history, you may be a candidate for the progestin-only pill or progestin-releasing Mirena IUD.

IUDs — intrauterine devices — are among the world's least expensive and most effective and popular contraceptives. Two types are available in the U.S. The ParaGard contains copper and can be left in place for 12 years. The Mirena continuously releases a small amount of the hormone progestin and is effective for five years. IUDs work by preventing fertilization. One or fewer of 100 women who use IUDs will become pregnant with typical use, which means not always perfectly consistent and correct.

Less effective options are prescription latex or silicone barrier methods, including the diaphragm, Lea's Shield, and FemCap. These methods are used with spermicide and placed in the vagina to cover the cervix. From 14-16 of 100 women who use these methods will become pregnant in one year with typical use. (FemCap is less effective for women who have given birth vaginally.)

I am a 42-year-old woman who lives a very healthy life. I eat lots of vegetables and fruits and do sports. I used to smoke two to four cigarettes a day, but I was never a heavy smoker. At present, I am seeing someone special, and I want to take the pill. Can I get the pill prescribed at my age?

Definitely. Women your age and older often choose the pill for its contraceptive and non-contraceptive benefits. Not only can the pill help prevent a surprise unintended pregnancy later in life, it can also help regulate menstruation during perimenopause, help reduce symptoms of PMS or certain symptoms of perimenopause, and help protect against ovarian and endometrial cancer.

The pill, however, cannot be used by women 35 or older who smoke, so it's a good thing you're no longer smoking.

One other thing: the pill cannot protect against sexually transmitted infections. So, even if that someone is special, be sure to practice safer sex, including condom use for sexual intercourse, until you are as certain as you can be that you are not taking any risks that could lead to dangerous infections, such as HIV.

I live in Louisville, KY and was wondering if Planned Parenthood here would be able to help me get an IUD. I've been on the pill for about eight years and just want to change methods. I never have unprotected sex, and I've been with the same man for 3.5 years.

Yes, Planned Parenthood of Louisville provides the two IUDs available in the U.S., the ParaGard and the Mirena. To find out what other services are available at the Planned Parenthood health center nearest you, you need only call toll-free 1-800-230-PLAN or plug your zip code in the clinic locator.

The IUD is safe and highly effective, and the most popular form of birth control in the world. More than 85 million women use IUDs. They are becoming more popular in the United States. Although the initial cost may seem higher than that of other methods, long-term use of the IUD can be less expensive. If an IUD is used for several years, the total cost becomes less than that of the supplies for monthly or quarterly methods, i.e., the patch, the pill, the ring, or the shot.

Women with certain conditions may not be able to use IUDs, but the IUD may be right for you if you

  • want a very effective, long-term, reversible method of birth control
  • are breastfeeding
  • cannot use combined hormone methods because you smoke or have certain medical conditions, such as uncontrolled hypertension
  • do not want to use hormone methods

Your contraceptive needs may change throughout your life. To decide which method to use now, consider how well each one will work for you:

  • How well will it fit into your lifestyle?
  • How convenient will it be?
  • How effective will it be?
  • How safe will it be?
  • How affordable will it be?
  • How reversible will it be?
  • Will it help prevent sexually transmitted infections?

Talk with your health care provider to help you make the best decision.

Does the patch work on anyone, regardless of size and shape? I heard that size affects the way a patch works on the person, so I just wanted to be sure.

The patch works for all women regardless of size. However, research has shown that the patch is slightly less effective for women who weigh more than 198 pounds. A couple of studies have also suggested that heavier women who use low-dose oral contraceptives may also be at slightly greater risk for contraceptive failure.

Although hormonal methods may be slightly less effective for women who weigh more than 198 pounds, these methods are still considerably more effective for such women than most other reversible methods, including the diaphragm, the condom, the sponge, fertility awareness methods, withdrawal, etc. The IUD is the only prescription method that can offer more protection against unintended pregnancy for these women.

The decision about what contraceptive method to use is one that should be made by each woman and her health care provider. Using hormonal methods consistently and correctly helps reduce the possibility of unintended pregnancy. Extended or continuous use may also increase effectiveness. Some women find that longer-acting methods such as the patch, the ring, or the shot are easier to use consistently and correctly. So a woman using the patch consistently and correctly and who weighs more than 198 pounds has a better chance of preventing pregnancy than a woman who sometimes forgets to take her birth control pills but weighs only 100 pounds.

Further studies are needed to help us understand whether there is a consistent relationship between body weight and hormonal contraceptive failure. In the meantime, a woman's individual needs should be considered whenever she considers choosing a hormonal contraceptive method, no matter how much she weighs.

My daughter is 12. I've talked with her about menstruation and sex. She hasn't started her period yet. Should I take her to my gynecologist for an exam when she starts? If not, what age should she go? Is it appropriate for me to start her on some type of birth control when she starts having her period? I had her at the age of 16, and I'm scared to death of her going through the same thing!

Gynecological exams are not necessary as soon as a young woman starts having her period. We now recommend that young women start having pelvic exams with Pap tests within three years of starting vaginal intercourse. If a young woman has not had first vaginal intercourse by age 21, then she should have a pelvic exam when she becomes 21 — even though she has not had vaginal intercourse. Of course, gynecologic visits are a very good idea if sexual or reproductive health concerns or problems arise earlier than within three years of starting vaginal intercourse or age 21.

Young women should be counseled about their birth control options before they become sexually active. They may want to consider taking regular, ongoing, highly effective hormonal prescription methods before beginning vaginal intercourse because of the health benefits of some methods. After they have been used for a few months, combined hormone methods such as the pill and the patch offer health benefits, including lighter periods, less bleeding during periods, less pain with periods, more regular periods, and reduced acne. Combined hormone methods also offer advanced protection against pregnancy as a woman reaches the point in her life when she decides to have vaginal intercourse.

When it comes to sexual and reproductive health, young women are often more comfortable with health care providers who are not also their parent's providers. Even young women who talk with their parents about sex and sexuality may be more trusting and confident with their own providers. Ask your daughter whether she wants her own personal health care provider — a doctor different from her pediatrician, your family-medicine doctor or nurse practitioner, or your gynecologist — to take care of her now that she is older. Respect whatever decision she makes, and help her to find a caring provider if she chooses to change providers. Regardless of the health care provider they choose, young people should be encouraged to have their visits in private — by themselves. They should also be given every assurance that their confidences will be respected.

I have breast cancer on both sides of my family and want to know if I can use combined hormone methods. I saw your answer to a question about the safety of hormone therapy. You said that "... combined therapy with estrogen and progestin slightly increases the risk of breast cancer. ..." Combined hormone birth control pills also contain estrogen and progestin. Do they also increase the risk of breast cancer?

No. The most recent literature suggests that the pill, or other combined methods, have little, if any, effect on the risk of developing breast cancer. It is not entirely clear why the combination of hormones used in hormone therapy for women during and after the change of menopause slightly increases their risk of breast cancer. We do know that women's risk of breast cancer increases with age and post-menopausal women are more likely to elect hormone therapy.

It is true that combined hormone methods of contraception — the patch, the pill, and the ring — should not be used by women who have had precancerous or cancerous growths of the breast because such abnormal cell growth may be sensitive to estrogen. Family histories of breast cancer, however, are not a contraindication for using combined hormone methods.

The birth control pill, the first combined hormone contraceptive method, is one of the most studied medications in the world. Studies about its safety have been ongoing for more than 40 years, and there is no evidence that women with family histories of breast cancer should not use it.

I've been using the shot for more than a year, and I'm not anywhere near as wet as I used to be. I am only 22 years old, and the only time I get wet now is if I am in the middle of extremely stimulating intercourse. I used to be wet just at the thought of stimulation. What can I do? Will it ever come back?

Hormonal methods of birth control may affect a woman's sex drive in different ways. Many women who use them feel less inhibited sexually because they don't have to worry about unintended pregnancy. Some women, however, find that the dose of hormones used in a method may inhibit their sexual desire and/or arousal. Inhibited sexual desire or arousal may, in turn, affect the way a woman lubricates. It may help to change the dose of hormones by choosing a different method — patch, pill, ring, or shot — or changing from one combined oral contraceptive to another. Many women choose non-hormonal methods, such as the IUD or fertility awareness-based methods, to avoid changes in sex drive.

Changes in sexual arousal and lubrication patterns may also be associated with other events in a woman's life. Having a new sex partner, or being with the same partner for many years, may affect the patterns of all the stages of a woman's sexual response cycle: desire, arousal, excitement, and orgasm. Various health conditions — including depression and diabetes, for example — may also affect her sex drive. Age itself also has an effect. In fact, during perimenopause and menopause, many, if not most, women experience vaginal dryness.

Women who would like increased lubrication should not be shy about using over-the-counter lubricants to enhance sexual pleasure. There are hundreds of products on the market to choose from. There are only two important cautions: Oil-based lubricants can damage latex condoms. Silicone-based lubricants can damage barrier contraceptives made of silicone, such as FemCap, and a wide variety of sex toys that are also made of silicone. So, if you use sex toys or latex condoms, you won't go wrong if you purchase a water-based lubricant.

I can't see a doctor at the present time, and I want to start using the patch. Would it be smart to buy birth control over the Internet? I don't think I need to have a pelvic exam because I'm not sexually active yet.

It's good to decide what birth control method you want to use before you start having vaginal intercourse. Getting prescription birth control online in the U.S. may be not be as easy as it might seem. Not all states allow online prescriptions for birth control. And there are very few legitimate sites that charge reasonable prices for providing prescription birth control online, such as the site for Planned Parenthood of the Columbia/Willamette in Portland, OR (you need to live in Oregon to use this online service).

Many women would like to use hormonal methods of birth control. But some, especially younger women, don't want to go to a health care provider because they'd rather not have a pelvic exam or a Pap test. Online access is not their only alternative, however. Many providers will allow you to postpone having the pelvic exam. This varies from provider to provider, so ask about this option. If you are allowed to postpone the pelvic exam, be sure to ask how long you can postpone it.

For a woman to use hormonal methods safely, it is important for a clinician to take her medical history — whether online or in person. That way, she can be evaluated for any of the contraindications that would make it risky for her to use a certain method. For example, women who smoke or who have migraine headaches with aura should not use combined hormone methods, such as the patch, the pill, or the ring.

Although online prescription may be convenient and have other advantages, there are also important health advantages to having a face-to-face meeting with a provider. It allows women with important questions to get answers they can't find on the Internet. Conversation and follow-up with a health care provider are important whenever prescription medication is used. Not all sites that offer prescription contraceptives do follow-up phone calls to see how a woman is doing with a new method.

There are legitimate sites on the Internet for getting prescription medications. But there are also sites that are not legitimate. Millions of dollars' worth of fake medications are sold online. Some won't work because they don't have the right ingredients. Some may include other ingredients that may be dangerous. People who order medication online need to be sure that the source is trustworthy and the prices are reasonable.

If you are seeking prescription contraception online because you fear having a pelvic exam or are unable to have a conversation about your contraceptive needs with your usual health care provider, you may want to change providers. Or you may want to make an appointment with the nearest Planned Parenthood health center.

My doctor told me recently that there is a new version of Norplant available that only uses one rod instead of six.  Is it available now?

The new contraceptive implant, Implanon, has been available for some time. This single-rod implant is inserted under the skin of the upper arm to provide birth control that is 99 percent effective.  It is definitely easier for health care provider to insert and remove a single rod than it was to insert and remove the six rods of the Norplant system. 

Although Norplant was an extremely safe and excellent form of birth control, many women experienced problems with removal because many providers were inadequately trained. The problems included pain at the insertion site and discoloring or scarring of the skin over the implants.  There were also the risks of minor surgery when removal was difficult.  To reduce the risk of all of these problems, a special insertion device to help ensure ease of removal has been developed for Implanon. 

As with any procedure, proper provider training and experience is a must.  Women who are considering using Implanon should ask their providers if they have been specially trained to insert and remove it and how many of these procedures they have performed.  Remember that it is always your right to ask questions. 

Side effects for some women are similar to those of the pill, patch, and ring.  Most women, however, are able to use Implanon comfortably and safely.  It is one of the most effective methods of contraception available in the U.S., including all reversible methods and sterilization for women and men.  And it works for up to three years.

I'm 17 years old and moved out of my parents' house three months ago. I have been dating the same guy for two years. When I asked my doctor for a prescription for birth control, he said I was too young to be having sex and that these days it's dangerous because of all the STIs. I didn't think my doctor could refuse it to me because of my age. Since he did, what do I do? Is there another way I can get birth control?

No health care provider is required by law to prescribe any medication to anyone. If a woman's health care provider refuses to prescribe a medication that she believes she needs, she needs to go to another provider.

You are being very wise and responsible to want to start using birth control before you become sexually active. You can call private physicians — in family practice, obstetrics/gynecology, adolescent pediatrics, and sometimes general medicine — in your area and ask their receptionists whether or not they prescribe contraception to women your age. Make an appointment with the health care provider who seems most likely to best serve your needs. You can also call 1-800-230-PLAN to make an appointment at the Planned Parenthood health center nearest you.

Until you have seen a provider, you can either abstain from intercourse or use an over-the-counter method of birth control whenever you have vaginal intercourse. You can choose from the latex condom, the female condom, the contraceptive sponge, or vaginal spermicide. (The female condom and the sponge are sometimes more difficult to find than latex condoms.) Use a latex condom with the sponge or spermicide to increase contraceptive effectiveness. Do not, however, use a latex condom with the female condom. Doing so may cause them to tear.

It's really important for people — women or men — to find health care providers they can talk comfortably with about their sex lives. It is an essential ingredient of good health care. If your health care provider doesn't want to deal with your sexual health needs, you really need to find another provider.

I've heard that the pill and other hormonal methods of birth control will lower my sex drive? Is that true?

All medications have side effects for some of the people who use them. The side effects of the pill have been studied for more than 40 years. Many of these studies have examined the effect of the pill on sexual desire and arousal. A recent review of 30 original studies concluded that using the pill, the patch, the ring, and the shot has no effect on sexual desire or arousal for most women. For other women, sexual desire and arousal are affected: Some experience more sexual desire and arousal. Some experience less.

The causes of these changes in sex drive are not clearly understood. Some may be psychological — for example, a woman may enjoy her sexuality more when she doesn't need to worry about getting pregnant. Some may be hormonal — for example, the estrogen in the pill may affect the testosterone in a woman's body in ways that influence her sex drive.

Women should watch for signs of side effects of any medication they choose. Women who use the pill and find that they have decreased sexual desire may want to try a different type of birth control pill or choose an entirely different way to prevent pregnancy. If a woman using other methods experiences an unwelcome change in her sex drive and thinks it is caused by her method, she may want to change to another method.

The key to successful use of hormonal methods of birth control is to have a continuing and open conversation with your health care provider. Be frank and open about your sexual concerns so your provider can offer the best advice possible.

My boyfriend and I are looking for a birth control method besides the use of condoms. I am looking into methods that are hormone free. I ran into a website selling "fertility monitors" that take the temperature under your tongue to indicate your fertility status. The website claimed that the monitor is nearly 100 percent effective. Is this true? Can you also recommend other effective hormone-free methods?

Alternatives to hormonal methods include barrier methods, such as male or female condoms, the contraceptive sponge, the diaphragm, Lea's Shield, and FemCap. These methods have somewhat less effectiveness than hormonal methods, but do offer significant protection against unintended pregnancy. Behavioral methods, such as withdrawal, outercourse, and fertility awareness-based methods, such as the fertility monitor you describe, offer somewhat less protection than barrier methods for typical users.

Most fertility monitors available through the Internet have not been approved by the U.S. Food and Drug Administration for contraceptive use. While they may be helpful for planning a pregnancy by identifying when a woman is likely to ovulate, they may be less helpful in preventing pregnancy. One reason is that sperm can live in a woman's reproductive tract for up to six days. So it is possible for a woman to become pregnant from vaginal intercourse up to six days before she ovulates.

If you decide to use a fertility monitor to prevent pregnancy, you should consult someone who has experience teaching or practicing fertility awareness-based methods of contraception (FAMs). An experienced counselor can help you learn to use other FAMs in conjunction with a fertility monitor to determine more accurately when to abstain from vaginal intercourse or use a barrier method.

For FAMs to be most successful, abstinence or barrier methods are used for many days during the woman's cycle. For example, couples who want to reduce the risk of pregnancy with the "Standard Days Method," avoid unprotected intercourse from Days 8 to 19 of the woman's cycle. (Day 1 is the first day of a woman's period.) This 12-day "fertile window" takes into account the six days before ovulation in which pregnancy can occur from vaginal intercourse and allows for a slight margin of error that may occur in predicting ovulation. The "Standard Days Method" can work for women who have cycles between 26 and 32 days.

The only reversible method of prescription birth control that offers the effectiveness of hormonal methods without hormones is the ParaGard copper T, an intrauterine contraceptive, (formerly called an IUD — intrauterine device), which can be left in place for up to 12 years. IUCs are more than 99 percent effective and are, in fact, the most popular reversible contraceptives worldwide.

Women and men who know they will never want more children than they already have may also choose methods that are intended to be permanent — vasectomy for men, tubal ligation for women. These surgical methods are difficult to reverse, so the couples who choose them must be sure that they don't want children in the future.

Eighty-five percent of women of reproductive age who use no contraceptives during vaginal intercourse become pregnant each year. The only guarantee against pregnancy is not having vaginal intercourse — continuous abstinence. Other contraceptive methods can greatly reduce the risk of pregnancy during vaginal intercourse.

No method of birth control is right for everyone. Although hormonal methods of birth control are safe and highly effective for most women, many women cannot use them. And some women do not want to use them.

Your contraceptive needs may change throughout your life. To decide which method to use now, you need to know

  • How well will it fit into your lifestyle?
  • How convenient will it be?
  • How effective will it be?
  • How safe will it be?
  • How affordable will it be?
  • How reversible will it be?
  • Will it protect against sexually transmitted infections?

Considering all these different needs can help you decide.

I am getting married and have been doing a lot of research on birth control. My church has introduced me to natural family planning — the Creighton model. I like everything about it, but my only hesitation is its effectiveness. I can't seem to find any "negative" statistics on this method and all the websites seem biased. It is very important for me and my future husband that I do not become pregnant, and I am very wary about the effectiveness of NFP. What are your thoughts on this method?

 Certainly, a high level of contraceptive effectiveness is critical for couples for whom it is very important to avoid unintended pregnancy. The most authoritative source we know for comparing the effectiveness of various methods of birth control is Contraceptive Technology, by Robert H. Hatcher et al., which is published by Ardent Media. The most recent edition became available in 2004. You can order it online or consult a copy in the reference section of your local library.

Contraceptive effectiveness is the rate of success of the use of a birth control method in the first year. It is calculated in two ways: typical use and perfect use. Typical use is the rate of effectiveness for couples who use a method incorrectly or inconsistently some of the time in the course of a year. Perfect use means that couples use a method correctly and consistently all the time over the course of a year. For example, of 100 women who rely on latex condoms for contraception, 15 will become pregnant in one year of typical use, but only two will become pregnant in one year of perfect use. So, for latex condoms, the typical-use effectiveness is 85 percent, while the perfect-use effectiveness is 98 percent. Sometimes we use the rates for typical and perfect use to express a range of effectiveness. In this example, the range for the condom would be 85-98 percent

Fertility awareness-based methods, which some people refer to as "natural family planning," are not as effective as some other methods, especially with typical use. For example, the ovulation, or mucus method, on which the Billings and Creighton models are based, ranges from 78-95 percent effectiveness. The symptothermal method, which combines the mucus method with the basal body temperature method, ranges from 80-98 percent. The new Standard Days method, which uses a string of colored beads with a movable marker to track the days of a cycle, is 88-95 percent effective.

According to Contraceptive Technology, the most effective reversible contraceptives — those that are not meant to be permanent — are the IUD (intrauterine device) and the hormonal methods — the pill, the patch, the ring, and the shot. The effectiveness of the IUD ranges from 99.2-99.9 percent. The effectiveness of the pill, the patch, and the ring ranges from 92-99.7 percent. And the effectiveness of the shot ranges from 97-99.7 percent.

Effectiveness, however, is only one of the considerations a woman needs to think about to decide what option will work best for her. To decide which method to use, you may want to consider how each method will work in eight other ways as well:

  • How well will it fit into your lifestyle?
  • How convenient will it be?
  • How safe will it be?
  • How affordable will it be?
  • How reversible will it be?
  • Will it help prevent sexually transmitted infections?
  • How important is it for you to prevent pregnancy?
  • How long do you want to prevent pregnancy?

While any contraceptive is better than none, the choice of method makes a difference. And studies have shown that women who use the method they most prefer are more likely to prevent pregnancy because they are more likely to continue using their method.

My girlfriend used to be bulimic, and as a result, hasn't had her period in about six months. Even though she hasn't had a period, can she still become pregnant?

Yes. You should use some kind of birth control whenever you have vaginal intercourse, unless you want to start a pregnancy. Even though your friend hasn't had a period for a long time, it is likely that her fertility cycles, including her periods, will return — especially if she is able to overcome her bulimia. And the tricky thing is that ovulation will occur before she bleeds.

It is important to remember that ovulation — the release of an egg from an ovary — occurs before menstruation. Pregnancy is most likely to occur from unprotected vaginal intercourse during the six days that end in ovulation. Menstruation occurs about 14 days after ovulation.

This means that a woman is fertile before her period begins. If she has not had a period for several months, it will be very difficult to predict when she will be fertile again. That's why couples who want to avoid pregnancy should be sure to use birth control, especially when fertility cycles are unpredictable.

My wife has been using the pill for 10-20 years and now plans to stop taking it. We've found a great deal of information about the temporary and long-term effects of being on the pill, but nothing about discontinuing it. Surely after taking hormones for so long there must be some effect when a woman goes off the pill. Has this been studied?

The pill is one of the most studied medications in the world, and we do know a lot about the experience of women who have used the pill for a long time. Here are the basics:

  • The protection the pill provides against cancers of the endometrium and ovaries continues for years after a woman stops taking it. (Eight years of combined hormone pill use reduces the risk of cancer of the endometrium by up to 80 percent. Ten years of combined hormone pill use reduces the risk of cancer of the ovary by up to 80 percent. These protections have been shown to last several years after stopping the pill.)
  • Women who stop using the pill lose its protection against acne, excess body hair, iron deficiency anemia, menstrual cramps, premenstrual syndrome — including such related symptoms as headaches and depression — and the vaginal dryness and painful intercourse associated with menopause.
  • Women who had irregular periods before taking the pill will probably have irregular periods again when they stop taking the pill.
  • Women who had regular periods before taking the pill may have a few irregular periods for a few months after stopping it. For women who have stopped having periods while using the pill, it may take a couple of months for periods to return. But no woman who stops the pill can assume that she will have any time of protection against pregnancy when she stops — the pill's pregnancy prevention effects diminish very rapidly.
  • The most recent literature suggests that long-term use of the pill has little, if any, effect on the risk of developing breast cancer.

Although studies have yet to be done, it is assumed that women who use newer combined hormone methods, i.e., the patch and the ring, will have similar experiences.

Of course, the most important change for a woman who goes off the pill is that she will lose her protection against unintended pregnancy. Women who stop using the pill and don't want to become pregnant need to be sure that they have another method in place as soon as they stop using the pill.

I've been married about three months. I am really worried about getting pregnant, but I'm not using any kind of birth control. Once in a while my husband and I use a condom. But most of the time we don't. The rest of the time, he pulls out before he ejaculates, but I heard that sometimes that just isn't enough. I'm afraid that if I use birth control for a long time that later on when I want to have kids I won't be able to. What would you suggest?

In fact, you already are using a kind of birth control. Withdrawal, when a man pulls out before ejaculating, may be the oldest birth control method in the world. Studies show that withdrawal is 73 to 94 percent effective, and that married couples are more likely than unmarried couples to get better results using it.

However, if you are really worried about getting pregnant, there are many methods of reversible birth control that are much more effective than withdrawal. And they will not affect a woman's ability to become pregnant in the future, no matter how long a woman chooses to rely on them. Hormone methods — the pill, the patch, and the ring — for example, are 92 to 99.7 percent effective. In a very few days after stopping these methods, the ability to become pregnant returns to what it was before using them. Another very effective method, the shot, is 97 to 99.7 percent effective. After stopping it, the ability to become pregnant returns to what it was, but it can take considerably longer — up to 18 months.

Married or not, couples who have great self-control, experience, and trust may be able to use withdrawal successfully. The men who use withdrawal must always be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. And they must pull out when they reach this point. If you decide to continue relying upon withdrawal, it's important to know that

  • Pre-ejaculatory fluid — the fluid that oozes from the penis before ejaculation — is not semen and does not contain sperm when it's produced in a man's body.
  • But if a man has had an ejaculation recently, the pre-ejaculatory fluid may pick up sperm that remain in his urinary and reproductive tract.
  • Pre-ejaculate that picks up sperm before oozing out of the penis could potentially cause a pregnancy, even if withdrawal is complete before ejaculation.

Every woman has to decide for herself what method will be

  • a good fit with her lifestyle
  • most convenient
  • as effective as she needs
  • as safe as she wants
  • as affordable as she needs
  • as reversible as she needs to plan her family if she chooses to have one
  • as protective against sexually transmitted infection as she needs

To make an appointment for confidential counseling about your options, contact your nearest Planned Parenthood health center.

I am currently on two different antidepressants, bupropion and fluoxetine. Is it possible for my birth control to become less effective as a result of taking anti-depressants?

No. Although it is not uncommon for different medications to affect each another, the prescription antidepressants bupropion (Wellbutrin, Zyban, etc.) and fluoxetine (Prozac, Sarafem, etc.) do not reduce the effectiveness of any contraceptive methods.

There are some types of prescription antidepressants, however, that are affected by hormonal methods. The effects of amitryptiline (Elavil, Endep) and imipramine (Tofranil, Norpramin, and others), may be exaggerated when using hormonal methods, such as the pill, the patch, or the ring.

Because medications often have interactions, it is always important to remember to discuss all the medications you are taking with any health care provider you see.

How soon after I stop using Depo-Provera can I plan on becoming pregnant?

On average, it takes up to six months longer for women to get pregnant after they stop using Depo-Provera than it does for women stopping other methods. The vast majority about 85 percent of those stopping other methods become pregnant within 12 months, but it takes up to 18 months for the same number of women to become pregnant after stopping Depo-Provera. About 90 percent of women stopping Depo-Provera become pregnant within two years. 

Of course, pregnancy may happen anytime after 12 weeks following the last injection. But the average time between the last Depo injection and pregnancy is about nine months, including the three months during which the injection is effective. This is why Depo is not usually prescribed for women who are planning to have a child in the very near future.

The fact is that some women just take longer to become pregnant than others, whether or not they have had injections of hormonal contraception. We strongly encourage you to consult with a qualified women's health care practitioner if you have not become pregnant within a year and a half after stopping Depo-Provera. It may be necessary to investigate areas other than contraceptive history in evaluating your fertility situation. 

For a confidential appointment, contact your nearest Planned Parenthood health center.

Isn’t it unhealthy for a woman to use a combined hormone contraceptive pill to put off her menstrual period for many months or years?

No, it’s not unhealthy for a woman to use combined hormone contraceptives to put off menstruation for months or years.  The lining of the uterus does not thicken in these circumstances.  In fact, over time, it becomes very thin, which is why some women stop having periods altogether after being on 28-day combined hormonal contraception for several months or years.

The progestins in combined methods prevent the lining from thickening.  Unchecked, unhealthy thickening of the uterus could be caused by estrogen when no progestins are present to keep that from happening.  But because estrogen alone cannot prevent pregnancy, there are no estrogen-only birth control methods. 

So, it is fine, and not unhealthy, for a woman on a combined hormonal contraceptive to not have periods.

Will having no periods for years at a time by using extended hormonal contraception — regular oral contraceptives, Seasonale, or Seasonique — lead to infertility?

No.  Extended use of oral contraception to avoid menstruation does not cause infertility or delay the return of fertility.  In fact, other than sterilization, which is intended to permanently end fertility, no method approved by the U.S. Food and Drug Administration leads to infertility.  Fertility returns immediately after women stop using IUDs, barrier methods such as the diaphragm, or hormone methods, including the pill, the patch, or the ring.  However, some women who use the shot — DMPA or Depo-Provera — may not be able to become pregnant for up to 18 months.

It may be helpful to know that the monthly bleeding that happens for women who use hormonal contraception is not the same as menstruation.  Menstruation only occurs to prepare the body for the next possible pregnancy.  The contraceptive hormones that prevent ovulation also prevent the body’s preparation for pregnancy.  The bleeding that occurs during the use of hormonal contraception results from the withdrawal of estrogen and progestin, instead of the surge of estrogen associated with the physiological onset of menstruation.

How do I decide which method of birth control is best for me?

Your contraceptive needs may change throughout your life.  To decide which method to use now, you should consider all the methods that are available and how each will meet your personal needs.  Here are seven key considerations:

1.  How well will it fit into your lifestyle?  Are you a woman who only has sex once in a while and doesn’t want to use birth control every day?  Are you a smoker who cannot use methods that include estrogen?  Have you completed your family and want permanent birth control?  Do you want a method that is very private so other people don’t know you are using it?  Are you a woman who can tolerate minor side effects for a while as you get used to a method? 

2.  How convenient will it be?  Are you a woman who wants a method she only has to think about once every five years?   Would you consistently use a method you need to think about every day?  Do you prefer to think about birth control only when you’re about to have sex?

3.  How effective will it be?  Are you a woman who wouldn’t mind if she had an unplanned pregnancy at this time in her life?  Do you need to be as sure as possible that you will not become pregnant?  Do you need protection against sexually transmitted infections as well as pregnancy?

4.  How safe will it be?  All birth control methods are safer than childbirth, but there are other safety issues to consider.  Would you use a very effective method that has very rare, but serious health risks?  Would you cooperate with the close medical supervision that may be needed if you have certain conditions that increase the risk of some methods?

5.  How affordable will it be?  Are you a woman who would prefer to pay a high up-front cost to get a long-lasting method that costs very little day-to-day?  Can you get financial support for the method you would like to choose?  Does your insurance cover the method you want?  Do you need to rely on low-cost over-the-counter methods until you can arrange for something more effective and more costly?

6.  How reversible will it be?  Are you a woman who is planning to have a child in a year or two?  Have you had all the children you plan to have?  Do you know if you’ll want children in the future?

7. Will it protect against sexually transmitted infections?  Are you a woman who has more than one partner in the course of a year or two?  Do you have a partner(s) who has more than one partner?  Do you only have sex with a partner who only has sex with you?

It will be helpful to keep your answers to these questions in mind as you compare the contraceptive methods that interest you. We've developed a useful tool to help you weigh all your options — My Method.

Talk with your health care provider if you are interested in the pill, the patch, the ring, the shot, the implant, the IUD, a prescription barrier like the diaphragm, or tubal sterilization.  Or make an appointment with the nearest Planned Parenthood health center.

I’m a single woman. I’ve used condoms during sex many times over the last few years. They have been all types, but I think mostly latex. I’ve never had a problem with them before, with or without lubrication, but last night it burned. I didn’t use extra lube, so it wasn’t that. I couldn’t tell if it was from the condom, but shortly after we started using it, it started burning, and we took it off. Can I form and allergy to something I’ve been in contact with for a long time? What are the symptoms for latex allergies? If I’m allergic to latex, what can I do?

Three possibilities come to mind. The first is that you may be sensitive to the lubricant that is used in the condom packaging. If that is the case, changing brands or using an unlubricated condom may solve the problem.

The second possibility is that you may have a vaginal infection. Itching or inflammation of the vagina can be caused by bacterial vaginosis, chlamydia, gonorrhea, trichomoniasis, or yeast infections.

The third possibility is that you have developed a latex allergy. As people grow older, some do develop allergies to substances that they could easily tolerate when they were younger. People with latex allergies — from two to seven percent of the population — may have skin rashes (eczema), hives, runny noses, or wheezing and difficulty in breathing. Severe reactions to latex include anaphylaxis, in which the throat quickly swells and constricts the windpipe, which may make it impossible for a person to breathe. Early warning signals for anaphylaxis include a tingling feeling, flushed skin, a rash, and dizziness.

Reactions to latex condoms may be immediate or occur up to 12 to 24 hours after contact. The vagina or penis may itch and there may be an itchy, scaly rash that is like poison ivy.

People who are allergic to latex may also be sensitive to bananas, avocados, or chestnuts, which are all related to rubber trees, from which latex is taken.

If it turns out that you are allergic to latex, you can use condoms made out of polyurethane — one brand is Avanti — or the female condom, which is also made out of polyurethane. Both offer good protection against unintended pregnancy and sexually transmitted infection. Some people who have latex allergies use natural membrane condoms — one brand is NaturaLamb. These offer fair to good protection against unintended pregnancy and bacterial infections like chlamydia, gonorrhea, and syphilis. However, they do not offer as much protection as latex condoms do against viral infections such as HIV/AIDS.

Is it safe to use both a condom and a diaphragm simultaneously?  If so, would that be a more effective birth control method than using either individually?

Yes.  Condoms can be safely used in combination with the diaphragm.  And, yes, using both at the same time will further reduce the risk of unintended pregnancy.

Latex condoms can be used in combination with most methods of birth control.  Not only do they increase a method’s effectiveness against unintended pregnancy, they also reduce the risk of sexually transmitted infection.

The female condom is the only method of birth control that should not be used with the condom. The kind of friction that develops between the latex condom and the polyurethane female condom can lead to breaks or tears.  It is also possible that the female condom may stick to the latex condom, and both may be pulled out of place.

Can a woman become pregnant if her partner pulls out before ejaculating?

It’s unlikely, if done correctly. Withdrawal, when a man pulls out before ejaculating, may be the oldest birth control method in the world. The World Health Organization says that about 35 million couples worldwide rely on withdrawal.

Some authorities are concerned that pregnancy may be caused by the pre-ejaculatory fluid that oozes into the vagina before withdrawal. Pre-ejaculatory fluid, however, is not semen, and it does not contain sperm when it’s produced.

But if a man has had an ejaculation recently, the pre-ejaculatory fluid may pick up sperm that remain in his urinary and reproductive tract. Studies have shown that the number of sperm picked up from previous ejaculations is very low — in the hundreds or thousands, instead of the millions that are released with each ejaculation. These numbers of sperm are usually considered too small to cause pregnancy, but they might — even if withdrawal is complete before ejaculation.

Men who use withdrawal as a contraceptive method must always be able to feel when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. And they must pull out when they reach this point.

Although withdrawal — also known as coitus interruptus — is often criticized as ineffective, it may be as effective as barrier methods, like the condom, female condom, or diaphragm. Studies show that withdrawal may be 73 to 94 percent effective, depending on how consistently and correctly it is used. Its users say that withdrawal has the advantages of being easy to access, easy to use, and free of side effects and cost. Non-users believe it causes anxiety and decreased pleasure during sexual intercourse. The most important disadvantage of withdrawal, even when used consistently and correctly, is that it offers no protection against sexually transmitted infections.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.
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Birth Control Q&A