Birth Control

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How do I know which method of birth control to use?

Effectiveness is not the only thing to consider when you are choosing a birth control method. You also need to look at:

  • your age
  • the number of partners you have
  • your current health and medical history
  • how effective the method needs to be
    • Ask yourself how you would feel about being pregnant if your birth control method didn’t work.
    • Ask yourself, if your method didn’t work and you did not want to be pregnant, how you would feel about having an abortion.

Age:

  • Some health care providers discourage using birth control pills during adolescence because of the potential effect on bone growth and the growing body’s development of normal ovulation.
  • If you are over 35 and smoke cigarettes, most health care providers will not prescribe birth control pills or any other method that contains estrogen because of the increased risk for blood clots

Number of partners:

  • If you have more than one partner, it is important to use condoms, especially for vaginal or anal sex, because of the risk of sexually transmitted infections (STIs).
  • If you don’t want to continue using condoms after three months with your partner, get tested for the common STIs as well as HIV before you start a new method. 

Current health and medical history:

  • If you want to use a hormonal method with estrogen, it is important that you do not have:
    • heart or circulation disease like high blood pressure,
    • a history of blood clots,
    • advanced diabetes,
    • acute liver problems,
    • migraine with aura, or
    • an estrogen-based cancer or a family history of this type of cancer.

What are the most effective methods?

Every method of birth control has a “perfect use” and a “typical use” number. This number stands for the percentage of women who would get pregnant in the first year of using the method. For example, perfect use of oral contraceptives (the Pill) is 0.3 (99.7% effective); but because women can make mistakes taking them, “typical use” is 8 (92%).

So the most effective methods (98% –99%+) are:

  • sterilization
  • intra uterine system (Mirena IUS)
  • combined oral contraceptives (the Pill), the Patch or the vaginal ring
  • Depo Provera (depot medroxyprogesterone acetate)
  • copper intra uterine device (IUD) 

Male condoms are an effective method. However, a man must use it correctly from start to finish. With perfect use 2 women out of 100 would get pregnant (98%); but with typical use, 15 would get pregnant (85%). 

What about withdrawal?

Withdrawal means pulling out the penis from the vagina before ejaculation.

  • With perfect use only 4 out of 100 women would get pregnant in one year, but with typical use 27 would get pregnant.
  • Knowing your fertile days helps you increase the effectiveness of withdrawal (see the Justisse Method of fertility awareness and the Standard Days Method).
  • Use condoms on your fertile days.
  • If a partner ejaculates by accident, consider taking emergency contraceptive pills (Plan B or Norlevo). 

Do emergency contraceptive pills work?

Emergency contraceptive pills (ECP) contain a synthetic progestin and can prevent or slow down ovulation to prevent conception.  They are also known as "morning after pills".

  • The sooner you take ECP after your method fails - or after no method was used - the better the chance of preventing pregnancy.
  • They are available over the counter.
  • If you do not get a period within 21 days, get a pregnancy test.
  • If you are pregnant and continue the pregnancy, the pills will not affect the fetus.
  • You can also use a copper IUD as emergency contraception if it is inserted within 7 days after your method fails or after no method was used.

I can’t use methods that have estrogen in them. What are my options?

Your options are:

  • Progestin only methods
  • Non-hormonal methods

Progestin only:

  • Progestin only pill (mini-pill)
    • must be taken at exactly the same time every day
    • often used with breastfeeding mothers
  • Depo Provera
    • injection once every three months
    • irregular bleeding most typical side effect
    • for about 50% of women, periods stop
    • side effects may last after stopping the method
    • may take up to 18 months after stopping the method to be able to get pregnant
  • Mirena IUS
    • similar side effects to the Pill (see below)
    • irregular bleeding
    • reduces bleeding
    • for some women, periods stop 

Non-hormonal:

  • Copper IUD
    • prevents conception
    • may cause some short-term spotting or cramping
    • for women who get pregnant using this method, higher risk of ectopic pregnancy (pregnancy outside the uterus) 
  • Male or female condom
    • male condom worn over erect penis before penis enters vagina
    • non latex male condoms available for people with latex allergies
    • female condom worn inside the vagina
    • female condoms not made of latex and conduct heat better than latex
  • Fertility awareness (see above) 

What about spermicides and the diaphragm?

There are several disadvantages with these methods:

  • Spermicides can irritate the vagina and increase risk of infection such as HIV.
  • Spermicides have a low effectiveness rate if used alone.
  • The jelly used with diaphragms is not currently available in Canada. 

I want to get an IUD and I’m 17. Can I?

Yes. The copper IUD is a safe and effective method. It’s best if you have only one partner. This reduces the risk of sexually transmitted infections (STIs), although health care providers may leave an IUD in place to treat an infection. You can use it: 

  • if you have normal bleeding, and
  • if you have no menstrual cramps or only mild ones. 

I heard the Pill is dangerous. Is this true?

There is a difference between side effects, which are temporary, and risks.  Some women have side effects; many do not. It is impossible to predict. The following are some of the side effects for oral contraceptives (the Pill), the contraceptive Patch and the vaginal ring. 

Side effects:

  • nausea
  • breast tenderness
  • headaches
  • spots of blood in underwear
  • mood changes 

These side effects usually go away in a few weeks but may last up to three months.

Here are some risks for the above methods:

The Pill also has some protective effects. Taking it can contribute to:

  • reduction in ovarian cancer, and
  • reduction in endometrial cancer.

Different pills use different synthetic estrogens and progesterones. Some are safer than others in terms of possible blood clots. 

I have terrible periods. Is there a method that can help?

Some methods help reduce bleeding. Some help reduce cramps. Some limit periods.

Reduced bleeding:

  • Mirena IUS (see above)
  • oral contraceptives (the Pill) (see above) 

Reduced cramps:

  • the Pill (see above)

Limited periods:

  • continuous oral contraceptives
    • can cause spotting of blood in underwear
    • Depo Provera (see above)
    • Mirena IUS (see above)

Where can I go for more information?

This FAQ may provide medical information, but is not meant to be a substitute for medical advice. When you have questions about your health, it is always advisable to ask a health care practitioner.

Created May 2013.