Contemplating contraceptives: Which birth control is best for you?

By in Features

For most sexually active university students, the last thing they want is an unplanned pregnancy. Choosing a method of contraception, however, can be both overwhelming and confusing. Whether you’re popping the pill, trying an intrauterine device or using good old condoms, there are some factors to consider when settling on a type of birth control that works for you and your partner.

Finding the right birth control has been a long process for Delaney Wright, third-year psychology student at the University of Saskatchewan. Wright started out using condoms and then moved to the birth control pill, finally settling on a hormonal IUD. She found that the pill made her moody and paranoid most of the time.

“With the pill — you know they say to set a time, so I picked a time that I thought would work for me, and then I wasn’t always able to take it right at that time. I know it’s a high effective rate, but I just was never 100 per cent confident in it,” Wright said. “I never really felt 100 per cent on it either. I just found it made my emotions kind of crazy, like when I would PMS it would be a lot worse. It sometimes made me ill too; I would feel nauseous from it.”

Wright had a hard time adjusting to the pill, and at one point was even combining methods of birth control, to ease her mind.

“For a while I was using condoms and the pill at the same time, because I was like, ‘Well if I use both of them, I should be good,’ but then birth control was just starting to take over my life. So finally I took a psychology of sexuality class [at the U of S] and the professor went over all types of birth control and talked about her own experiences, and after that I looked more into IUDs and decided I wanted to go with one of those.”

In a 2009 national survey published in the Journal of Obstetrics and Gynaecology Canada on Canadian women and contraceptive use for vaginal sex, the two most common forms of birth control reported were condoms and oral contraceptives. Condom use was reported at 54.3 per cent, while oral contraceptive use was 43.7 per cent — out of a total 144 per cent, because the women surveyed could list more than one method of birth control used in the past six months.

Interestingly, the third most common method listed was withdrawal, at 11.6 per cent. Dr. Melissa Mirosh, gynecologist and faculty member in the department of obstetrics and gynecology in the College of Medicine, confirms this is still an accurate trend.

“By far the two most common methods are actually condoms and withdrawal — neither of which are particularly good contraceptives. But from a prescribed standpoint, oral contraceptives lead it by far,” Mirosh said.

Mirosh emphasizes that condoms just don’t cut it when it comes to birth control.

“In my world, I talk to people about condoms as infection protection, not birth control. They’re better than nothing for birth control, but not by much,” she said.

The problem with condoms, according to Mirosh, is that they require the male partner to be willing to consistently wear one, which doesn’t always happen. Birth control then falls into the lap of the female.

“Guys may start off with condoms; they tend to not last very long, unless it’s the primary method that they, as a couple, are trying to use. I have to say, most late teens and early 20s women, for the most part, are not aggressive enough with their partners in terms of demanding that that stuff happens,” she said. “They cave in to what the guys want to do. And most guys, when given the choice, would rather not wear a condom.”

The most commonly prescribed method is oral contraceptives — also known as the pill — which is a hormonal method of birth control that releases estrogen, progestin or both, depending on the type. It works by thickening the cervical mucus to prevent sperm from reaching the egg, which makes implantation of the egg in the uterus difficult.

The pill does have a 99.9 per cent rate of effectiveness, but its success relies on the user taking it at the same time each day.

“If people have difficulty trying to remember to swallow a pill everyday, well, the birth control pill only works as well as you take it. If you can’t take it reliably, then it’s probably not a good choice,” Mirosh said.

Other, less common hormonal methods include the vaginal ring, contraceptive patch, birth control injections and IUDs.

An IUD is a small, T-shaped frame inserted by a doctor into the uterus, and it is 99 per cent effective. Hormonal IUDs release the hormone levonorgestrel, which causes the cervical mucus to become thicker and the uterine lining to become thinner, making it more difficult for sperm to enter the uterus.

Wright is currently using the hormonal Mirena IUD, and has had success thus far.

“It’s actually been great … It was really easy; I was probably at the [doctor’s] office for only a half hour. Basically she put it in and I was good to go,” Wright said. “If you haven’t tried [an IUD], I’d say to give it a shot. Because if it works for you, you can go five years and not have to think about it again.”

IUDs can also be non-hormonal, more commonly known as the copper IUD, which contains a thin copper wire in the T-frame, that destroys sperm by changing the chemistry of the uterus.

According to Mirosh, when it comes to natural or non-hormonal methods of contraception, the copper IUD is the best option.

I also asked Mirosh about other natural methods of birth control, such as Natural Family Planning — planning sexual activity around a woman’s predicted fertility cycle — which often gets a bad reputation.

“There’s a running joke of ‘What do you call people who use that method?’ Parents. I mean, when used properly, it’s not bad. The problem is that you have to have really regular cycles, you have to be really attentive to when your fertile times are, and both you and your partner have to be willing to abstain [from sex] at certain times of the month, and that’s behaviour that’s typically not characteristic of university students,” she said.

This doesn’t seem to be the case for Katrina Dixon, first-year student in the College of Education. Dixon uses the NFP Marquette method with her husband and thinks there have been many positive aspects of using natural birth control.

“We have to have a conversation every month, like, ‘Do we want to have a baby or not?’ and that’s helpful in that it keeps us on the same page and brings us to respect each other more and our bodies — so the fact that I’m sometimes fertile and sometimes not, and that’s the variable that we have to work with. Just that respect for ‘This is what our intimacy can do,’ and we need to be conscious of that,” Dixon said.

There are four common types of NFP, each of which require the female to track and chart her menstrual cycle. The methods are called Billings, Creighton, Serena and Marquette, and they all use some combination of monitoring cervical position, temperature of the cervix and/or checking cervical fluid to see if the woman is fertile or not. The couple then either has sex or abstains from sex, depending on whether they are trying to get pregnant or not.

Dixon acknowledges the tracking was initially a learning curve, but they figured out how to do it despite the fact that she has a “regularly irregular” cycle.

“A lot of people have really false conceptions of how reliable it is,” she said. “A lot of people think about the rhythm method, which wasn’t very reliable; we’ve gotten much more sophisticated in our understanding of a woman’s body.” 

Dixon also mentions that many don’t find NFP appealing because it does require abstaining from sex for periods of time when the woman is fertile, if trying to avoid pregnancy.

“A lot of people don’t like the idea of having to abstain for any period of time. It’s this flaw of, ‘Oh, you mean I have to exercise self-control and not be gratified immediately?’ Yes. There’s an element of sacrifice there, but to me that sacrifice just makes our intimacy more meaningful and makes us respect and communicate more,” she said.

Although NFP is perhaps the healthiest form of birth control, it does sound like more work than other hormonal types. According to Mirosh, considering the amount of effort you want to put into your birth control is important.

“The main thing people need to think about is how reliable are they going to be about taking it, because the more you have to think about your birth control, the less well it will work. That’s why things like IUDs typically have lower failure rates, than things like condoms or oral contraceptive pills, where you have to think about it regularly or on a daily basis.”

“When I talk to people about birth control, my first question is, ‘How devastating would an unplanned pregnancy be?’ And for most folks who are in university, it would be bad,” Mirosh said.

Mirosh has noticed a trend among birth control users: if someone doesn’t like the birth control they’re on, they quit the method and switch to something that is less effective. She urges students to talk to their doctors instead, if their birth control isn’t working.

“What I ask all my folks to do, is if you’re starting something and you don’t like it, please come back and talk to me, so we can set you up with something else. Because there’s usually lots of options and ways to tweak it or make it better,” she said.

When having an issue with birth control, many turn to the Internet to read up on side effects or find horror stories. Mirosh recommends making note of these concerns and taking them to someone who knows both sides of the story.

“Beware of what you read on the Internet, because it’s usually the highly negative. That being said, make note of them and bring them in when you go to talk to whoever you’re going to talk to. Then people who know what they’re doing are going to be able to tell you how likely or unlikely those scenarios are.”

Methods of contraception currently being used by U of S students:

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Methods of contraception currently being used by Canadian women who had vaginal intercourse in the previous six months:

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Naomi Zurevinski / Editor-in-Chief

Infographics: Jeremy Britz / Graphics Editor