SEXUAL HEALTH: Birth Control Options
Updated: Mar 16
Girls girls girls girls girls. Do you know how many options are out there for birth control these days? I can't stress how BIG of a decision this actually is. You. Are. Putting. Something. In. Your. Body. Well, most likely. Unless you're choosing to track your cycle the good ole' fashion way (which I COMPLETELY support).
It's always good to be aware of your options before seeing your OBGYN. Let's dive into your options from least to most invasive:
Natural Family Planning - Basal Body Temperature, cervical mucous, and LH charting are the most natural routes and empowering ways for you to get to know your body without putting anything INSIDE of your body. All three will help you figure out when you are ovulating, and therefore likely to conceive. Basal body temperature forces you to wake at the same time to take your temperature EVERY MORNING...which, I'm not a huge fan of since sleep is ultra important. It also only has an accuracy rate of about 76-88% depending on your consistency. The cervical mucous method, on the other hand, is SUPER SIMPLE and up to 97% accurate IF used correctly. If you want to simplify even further, you can use the 2-day method by asking yourself the following questions: "Do I have slippery egg-white cervical mucous today?" "Did I have slippery egg-white cervical mucous yesterday?" If you answered "no" to BOTH questions, you are likely in an infertile day. If you answered yes to one or both questions, you have a chance of becoming pregnant. If you use this method, you may only have 12 days of infertile days per cycle. Testing your estrogen and LH hormones is always another alternative. These both rise around ovulation and can be as simple as peeing on a stick. Regardless of your choice, if you choose Natural Family Planning, PLEASE KEEP IN MIND that while first starting out and tracking your cycle, it's suggested to use an additional means of contraception as a precaution until you are familiar with your cycle (ex: adding condoms and the pull-ou. This is because the above methods will help indicate when you are ovulating however, note that you are most likely to get pregnant the days before ovulation meaning that if you have intercourse on Monday, then have ovulation signs on Tuesday, it may be too late.
Male condoms - It's nice to put the effort of the guy but, let's be honest, the user failure rate of a condom is 15% which would make anyone nervous. However, if your man is skilled and uses condoms flawlessly, his perfect failure rate from condom breakage decreases to 2%. And, unlike the other contraceptives mentioned in this blog post, the tried and true condom is still the only method that reduces risk of STIs. No wonder they still talk about these in Phys Ed and college orientations.
Phexxi - a non-hormonal prescriptive vaginal gel used immediately before intercourse. It works by changing the pH to immobilize sperm but does not contain the old fashioned spermicide chemicals that most women find irritating. As an added bonus, Phexxi contains non-toxic, food-grade ingredients! Keep in mind that Phexxi is only effective when used immediately before (or up to 1 hour before) intercourse. I LOVE this product.
Cervical Cap - This is a reusable cervical cap made of non-allergenic, durable, surgical-grade silicone. Think upside down Diva Cup. It can be used with a spermacide for added protection. Contrary to popular belief a cervical cap does not require custom fitting and is super simple to use: Insert up to 40 hours prior to intercourse and leave it in up to 48 hours. Despite all the effort, it still has an 8% failure rate even with spermacide.
Copper IUD (Paragard)- If you don't want to be responsible for keeping Phexxi or a cervical cap in your back pocket or tracking your cycle, the next best option is a non-hormonal copper IUD. Used for centuries (originally in camels to prevent them from getting pregnant on long journeys across the desert), a piece of copper causes irritation in the uterine lining to prevent adherence of an embryo and is 99.9% effective. HELLOOOOOO. I LOVE this option for women who DO NOT experience menstrual cramping and want to enjoy spontaneous intercourse. There is a 5-year copper IUD in Canada that I wish with all my heart we had available in the States. Unfortunately, as of 2022, the US only offers a 10-year one which contains more copper and therefore seems to cause more cramping. IF you decide to take the copper IUD route, make sure you supplement with 15mg of zinc daily...as copper competes with zinc for absorption. Getting pimples after a copper IUD? Hint hint, you're likely zinc deficient.
Progestin IUDs (Mirena, Skyla, and Liletta) - And now we get into the hormones. Which, to be honest, terrifies me a bit as a Naturopathic Doctor UNLESS you are trying to mimic the natural cycle. Most contraceptives go against the natural flow of hormones and tend to cause detrimental side effects as a result (headaches, liver damage, estrogen dominance, cardiovascular diseases, chronic pain, mood swings, weight gain,...). On the other hand, it CAN sometimes be used as a treatment for various conditions such as estrogen dominant conditions (endometriosis, anemia, fibroids, PCOS). Of which, I'm a fan. Also, it's 99% effective which is a nice peace of mind. Overall, these seem to be hit or miss depending on side effects that you can only find out once you get the IUD (weight gain, bloating, cramping, breast tenderness, acne, moodiness...).
Vaginal Ring (NuvaRing) - Hard "no" from me. Most of our girls these days have too much estrogen in their bodies as it is from of dairy, meat, and plastic-leaching supply. Although the ring is nice for the pure flexibility of removing it whenever your heart desires, I just don't trust the constant estrogen released into the body that prevents ovulation - a natural and cleansing process. Along with the fact that it's only 91% effective, the never-ending list of contraindications ought to be a red flag: Histories of blood clots, high blood pressure, smoking, migraines, breast cancer, diabetes, and weight gain. IF you do decide to take the NuvaRing route, please please please leave it in for 21 days and remove it for 7 days for best long-term health outcomes.
Oral Birth Control or the Patch - Sometimes these routes are indicated for medical health conditions although, I'd say for the average patient of mine, this is another hard "no." Unlike most of the methods above, oral birth control and the patch introduce hormones body-wide rather than locally. Which makes sense when we see side effects that result in dose-related effects on blood pressure, increased risk of cervical and breast cancers, liver damage, and B-vitamin depletions. If you're irresponsible, keep in mind that they are rendered inefficient if a day is missed - not your cup of tea. On a positive note, they are preventative for uterine and ovarian cancers. Risks and benefits are the same whether pulse-dosing or using them continuously. All to say, not my favorite of options for obvious reasons.
Male vasectomy, tubal ligation, tubal implants - If you know that you know that you know that you don't want to have children, by all means pull the plug. If your male partner is willing to have a vasectomy, this is by far the best choice. It's a simple procedure, cost-effective, and has limited risks and complications. It's VERY unlikely that a vasectomy will cause erectile dysfunction (which is a large fear from most men who agrees to this option) AND it's one of the most reliable forms of birth control. If tubal ligation is the chosen option, make sure to talk to your doctor about the severe adverse effects prior to surgery. And if you change your mind one day, reversal of both surgeries is possible. Pregnancy rates after reversal of either a vasectomy or tubal ligation is around 30-80%.
If you want more information on contraception OR fertility, book a free meet & greet with me to see if we'd work well together.
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Until Next Time,
Dr. Chelsea Leander ND, RH (AHG)
This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.