The Birth Control Roundup
If you are anything like me birth control choices have been a pain in your A*# since high school. As people with vagina’s we’ve been thinking about our responsibility to stay baby free since sex ed class. And despite everyone telling us this is supposed to be a shared responsibility and a shared choice - we know all too well that the labour of thinking about, choosing, paying for and remembering to take or use birth control tends to fall squarely on us - the people with the vaginas. Tell me how many times you have had to remind or ask a dude to use a condom as he tries to get it in there - as if getting pregnant is just like soo not a big deal for him.
Anyways, I’m ranting here. You can tell this is a topic I’m passionate about. We all have our own relationship with birth control. Maybe you used to pill to save us from crazy period cramps and it made your life better, maybe you were like me and you went through the round up of pills and other tools and just didn’t find anything that felt really worked or whose side effects you didn’t mind.
I was on and off the pill for years and then finally decided to go IUD. The copper didn’t agree with me so I reluctantly went hormonal. And while it was really nice to take worrying about unwanted pregnancy off the table I got it right as I was learning the power of connecting to my menstrual cycle (see my blog on connecting to your hormones) INSERT LINK. As a result I was quite conflicted on insertion day and it ended up being quite traumatic. I lost my period for five years and when I got the IUD out five years later I fainted in my docs office like three times. It was quite the process.
So now that I’ve had the baby I wanted, now what. For some reason when I was younger I thought there was this magical post baby land where I wouldn’t have to think about these choices anymore. Wouldn’t have to subject my body to hormones and devices and trauma just to avoid more pregnancies. Turns out that mystical land only exists after menopause and I am a ways away from that. So what's a girl to do in the meantime.
Well, in case you needed a refresher I’m going through your basic birth control options below. I know, I know, this feels like old territory but I gotta say when I was taking my sexual health educator training I learned a thing or two and you might as well. I’ll share my faves for me personally and some new resources you might not have. Remember to check in with your doc about your health history and other factors that may affect how well a certain method will suit you and your body. Only you can make the best choice.
Things to consider when choosing birth control:
How effective is it?
Given your lifestyle and routine how consistently can you use it?
What are the side effects?
Health history and suitability given other medical conditions?
Are you going to have more babies?
How much does it cost and can you access it easily?
So birth control comes in two basic forms. Barrier methods and hormonal methods.
Barrier methods physically stop the sperm from coming into contact with the egg. They do this by preventing the sperm from entering the vagina by killing them or making the vagina inhospitable to them. Most barrier methods are used each time you have sex.
Tubal Ligation (Tying your tubes)
Copper or Hormonal Intra Uterine Device (IUD)
Female/ Internal Condom
Diaphragms / Cervical Caps
Spermicide/Sponges and Other
Hormonal methods use hormones to stop the release of an egg. Estrogen and Progesterone in different combinations are used to block the signals between your brain and ovaries. They prevent an egg from being released and therefore there is no egg in the fallopian tube to meet any of the sperm that arrive. Hormonal methods are used on an ongoing basis.
The shot/ Depo Provera/ or Depo
Side note - I know my jaw dropped as well when I learned that IUDs are barrier methods. They work by thickening the cervical mucus so the sperm cannot enter the uterus, they also irritate the uterus so the lining that supports the fertilized egg doesn’t work.
This infographic from Options for Sexual health is a great overview of failure rates and effectiveness.
I’m not going to go into detail about each of these methods. You are likely already familiar with many - but you can use the links above to learn more about each one and how they work.
What I do want to share is my top three choices and why.
#1 Vasectomies for Everyone!
I am soooo done with torturing my body to avoid a baby and I am 100% a fan of passing that on to my man. Especially when the surgery is very minor, non invasive, extremely effective, and reversible in many cases. So many women I talk to are all about this but find their husbands reluctant to book an appt with the doc because they are squeamish about surgery on their precious jewels and worried about their loss of masculinity. Well I say F THAT BS. You have pumped yourself full of hormones, screwed with your libido, messed with your period and your health, freaked out when you forgot a pill, and so much more - all so he never had to think about it. If you are both ready to close the factory as they say than he can get one small quick surgery.
Here’s a great podcast episode I highly recommend listening with him, or putting on while he is in earshot. It’s called Alpha Dad gets Snipped and a man documents his vasectomy process and the things he learned.
Check out this link to planned Parenthood for the 411 on all things vasectomy. Read it together and if it’s right for your family go for it!
2) Fertility Awareness
This is a really interesting method that for me has a few side benefits that are not related to pregnancy prevention. Fertility awareness is all about tracking your cycle and knowing your body. By tracking your period, your basal body temp and your discharge you can develop an understanding of your fertile window. You abstain or use other birth control methods during the 5-7 days you could get pregnant each month.
Now, in order for it to work you have to be in tune with your body AND you have to be good about using other methods during your fertile window. These days there are many many period tracking apps and even an FDA approved app and thermometer that can be used to help you do this.
The reason I am a fan is that connecting with your cycle is not just about knowing your fertile days. Connecting with your cycle brings you into communication with your body. It helps you tune in to when you need rest and when you are ready to get out in the world. Your period is like the fifth vital sign. How it functions says a lot about your overall health. Your period is one way your vagina communicates with you and when you are in dialogue with her every day you know what’s going on.
So many of us are totally out of sync with our bodies. Our period is surprise every month and we have no idea why things get a little slippery once a month down there (that’s your ovulation discharge miss).
I am personally going this route for now - which means a few very cautious months until I get the hang of my cycle. To be fair we are also on the - we’d be ok if we had another one fence - so we feel great about this choice for now.
3) Set it and Forget It
If you are more the set it and forget it type then I definitely recommend an Intra Uterine Device (IUD). Whether copper or hormonal they are extremely effective and low impact. They work in three different ways to prevent pregnancy:
They prevent the sperm from entering the uterus by thickening the cervical mucus
They prevent a uterine lining from growing meaning a fertilized egg has no place to land
They make the vagina less hospitable to sperm.
They can also be used as an effective morning after pill alternative (they are much more effective than the morning after pill btw). They are also relatively inexpensive (at least the copper is). You don’t have to think about it every month. IUDs have changed a lot since your mom’s horror stories (in fact I myself am the result of a failed IUD that was not properly inserted).
Make sure you get a doc who puts them in regularly or visit a fertility or women’s clinic where they do so regularly. This will ensure proper placement. When I had mine in they did it and I went back and they checked with an ultrasound to ensure it was correctly placed and positioned.
You may or may not continue to get your period and even if you go the hormonal route it’s far less hormones than an ongoing monthly pill or patch.
Phew - that was a big one. Thanks for staying with me till the end. At the end of the day I am so grateful for these birth control choices - they give me and all women the option to exert choice and control over their own bodies and their reproduction. At the same time, the lack of men’s options and the acceptance and tolerance of side effects from lack of libido and reduced fertility are a challenge. It sucks that we carry the burden of responsibility - most often - alone and that thinking about and experimenting with different methods can be such a challenge.
I’d love to hear in the comments what your experiences have been with birth control. What are your top choices? What’s worked best for you? Are you vowing to go hormone free? How come? Do you talk about it with your partner and is a vasectomy on the table at your house?
Share in the comments or send me an email at email@example.com.