Birth Control

The birth control pill is a medication taken by mouth at the same time every day to prevent pregnancy. It contains two types of hormones normally found in your body - estrogen and progestin. The birth control pill is 91% effective with typical use. 

How does the birth control pill work?

The birth control pill prevents the ovaries from releasing an egg each month (ovulation). If there is no egg to meet the sperm, pregnancy will not occur. It also changes the lining of the uterus making it difficult for an egg to attach itself. Finally, the pill changes the mucus in the cervix making it harder for sperm to enter the uterus.

How do I use the birth control pill?

Begin taking the birth control pill on the first day of your period or on the Sunday following the first day of your period. You must take the pill around the same time each day to avoid pregnancy. Try to take the pill with a scheduled daily activity such as a shower or breakfast.

• 28-day packs: Take one pill every day for 28 days. The first 21 days will consist of hormone pills. The last 7 days are inactive pills (hormone-free). Your period should begin while taking the 7 days of inactive pills. Start a new pack after completing the previous one, even if you are still having your period.
• 21-day packs: Take one pill every day for 21 days. Stop taking the birth control pill for 7 days, your period should begin during this week. Start a new pack of pills after the seven-day break, even if you are still having your period.

It takes 7 days for the birth control pill to start taking effect and prevent a pregnancy. Use a back-up method of birth control during this time to prevent a pregnancy, such as condoms or abstinence. If this is the first time you start taking the birth control pill, it is best to use a back-up method for the first month, as you adjust to the routine of taking a pill every day. 

Advantages, side effects and possible complications of the birth control pill

Advantages:

• Decreases menstrual cramping and bleeding
• Improves your cycle control
• Reduces the risk of ovarian and endometrial cancer
• Can reduce acne

Possible side effects:

Not everyone experiences side effects when starting birth control. If you do, they will likely resolve within the first three months. If you are experiencing side effects and are considering stopping birth control, consult your health care provider to explore other options:

• Irregular bleeding (bleeding in between your periods)
• Nausea
• Headaches
• Sore breasts
• Mood changes
• Water retention

Possible complications:

If you have any of these symptoms while on the birth control pill, you should go to the hospital immediately:

• Abdominal pain: severe pain or lump in the abdomen
• Headache: severe with dizziness, weakness or numbness

• Chest pain or shortness of breath

• Eye problems: vision loss, blurred vision or speech problems
• Severe leg pain or numbness: calf or thigh

Remember:

• The pill does not protect you against sexually transmitted and blood borne infections (STBBIs) including HIV; use condoms to lower your risk.
• If you are taking medications such as antibiotics or street drugs, verify with your health care provider before starting birth control.
• If you have any vomiting or diarrhea, continue to take the pill but use a backup method of birth control (such as condoms) for the rest of the cycle.

I forgot my pill. What should I do?

Which week of your cycle did you forget to take the pill? 

How does Depo-Provera® work?

Depo-Provera® prevents the ovaries from releasing an egg each month (ovulation). Depo-Provera® also changes the lining of the uterus making it difficult for an egg to attach itself. Finally, Depo-Provera® changes the mucus in the cervix making it harder for sperm to enter the uterus. 

Who can use Depo-Provera®?

All individuals seeking a reliable and reversible method of birth control that requires little attention. Also, Depo-Provera® may be a good option for people who are unable to take estrogen. However, there are certain health issues for which Depo-Provera® is not the best option.

How do I use Depo-Provera®?

Depo-Provera® must be injected into the upper arm (deltoid muscle) or the hip (gluteus muscle) by a health care provider (HCP):

• During the first 5 days of your period;
• During the first 5 days of stopping the birth control pill, the Evra® patch or the NuvaRing®;
• During the first 5 days after an abortion;
• During the first 5 days after having a baby if not breast/chestfeeding. If breast/chestfeeding, wait 4 to 6 weeks until breast milk is established;
• Any time during the menstrual cycle until pregnancy or the possibility of pregnancy can be ruled out.

If given within the first 5 days of your period, Depo-Provera® is effective within the first 24 hours. If given after the first 5 days of the menstrual cycle, a backup method of birth control should be used for the next two weeks.

Late injection

If it has been 13 or more weeks since your last injection (shot), use a backup method of birth control such as condoms until the next Depo-Provera® injection can be given and for two weeks after having the injection. 

What are the advantages, possible side effects/complications of Depo-Provera®?

 Advantages:

• Convenient – one shot every three months
• Some people stop having their periods
• Decreased cramping and menstrual bleeding
• Reduced risk of endometrial cancer
• Reduction of symptoms linked with endometriosis, premenstrual syndrome and chronic pelvic pain
• Decreased incidence of seizures
• Possible reduced risk of pelvic inflammatory disease

Possible side effects:

• Reduction in bone mineral density (bone mass);
• Menstrual cycle changes (irregular bleeding);
• Hormonal side effects:
  • Headache
  • Acne
  • Decreased libido
  • Nausea
  • Breast tenderness
• Weight gain due to appetite stimulation
• Mood effects

What is the internal condom?

The internal condom, ®, is a soft, thin, loose-fitting polyurethane sheath with two flexible rings at each end that is inserted vaginally or anally. The inner ring at the closed end of the condom is used to insert the condom and to keep it in place. The outer ring at the open-end of the condom stays outside the vagina or anus and partially covers and protects the lips of the vagina or edges of anus. The internal condom is 79 to 95 per cent effective if used the right way.

How does the internal condom work?

The internal condom prevents semen (sperm) from entering the vagina or anal canal and it prevents the exchange of bodily fluids between both partners. The internal condom protects against unintended pregnancy, sexually transmitted and blood borne infections (STBBI) including HIV.

Who can use the internal condom?

People who engage in vaginal and/or anal sex.

How do I use the internal condom?

1. Check the expiry date.
2. Check the package (It should be sealed and not ripped)
3. Find a comfortable position. Stand with one foot up on a chair, sit with knees apart, or lie down.
4. Be sure the inner ring is at the bottom, closed-end of the pouch.
5. If you wish, add a drop of extra lubricant to the outer part of the vagina, anus and in the anal canal for extra comfort when you insert the condom.
6. Hold the condom with the open end hanging down. While holding the outside of the pouch, squeeze the inner ring with your thumb and middle finger.
7. Place your index finger between the thumb and middle finger and keep squeezing the inner ring. With the other hand, spread the labia (lips) of your vagina or anal edges and insert it into the vagina or rectum.
8. Slowly push the inner ring and the condom all the way up into the vagina / rectum with your index finger. You can go as deep as you are comfortable. Check to be sure the inner ring is up just past the pubic bone for the vaginal site -the outer ring stays outside the body.
9. Before intercourse, make sure the condom is not twisted and that the outside ring lies against the vulva or anus.

10. You may want to add some lubricant to your partner’s penis or toy to avoid having the condom slip off.

11. During intercourse, side-to-side movement of the ring is normal, but if you feel the ring slip into the vagina or anal canal or the penis starts to enter underneath the condom, stop.

12. After intercourse, remove the condom before you stand up. Squeeze and twist the outer ring to keep the sperm inside the condom. Pull out gently. Throw away in a trash can.

13. Use a new condom every time you have sex.

What are the advantages, possible side effects/problems of the internal condom?

Advantages:

• An individual can insert it and has full control over its effectiveness in preventing unintended pregnancy and STBBIs, including HIV  
• It adjusts well to the vagina or the anal canal
• Non-latex
• Compatible with oil-based products

Possible side effects/problems:

• Allergy to polyurethane and irritation
• Slippage
• Insertion difficulties
• The inner ring may cause discomfort during sex

Intrauterine Contraception - Intrauterine Device (IUD) 

• IUDs are methods of birth control inserted inside the uterus (intra-uterine) and are at least 99 percent effective in preventing pregnancy for 5 to 8 years
• The copper IUD does not contain any hormone
• Hormonal IUDs contain one hormone called progestin
• IUDs must be inserted by a health care professional (HCP)
• The copper IUD can also be used for emergency contraception if inserted within 7 days of unprotected sex

How do IUDs work?

• The hormonal IUD thickens the mucus in the cervix, making it more difficult for sperm to enter the uterus, it thins the wall of the uterus and thus prevents implantation in the uterus
• The copper IUD primarily inhibits sperm from reaching an egg and impairs implantation in the uterus

How do I use IUDs (hormonal or non-hormonal)?

• IUDs are inserted by a health care practitioner at our clinic. You will have a phone assessment to make sure you are a good candidate for the device.
• If you choose a hormonal IUD, a prescription will be faxed to your pharmacy.  You will bring the device to be inserted to your insertion appointment.
• If you choose a copper IUD you may purchase it at our clinic.
• IUDs can be inserted any time during your cycle as long as pregnancy is ruled out.
• The copper IUD is effective immediately. The hormonal IUD (Kyleena or Mirena) is effective 7 days after insertion.
• Check your IUD strings monthly. If you feel the plastic part of your IUD or if the strings are absent or longer than usual, use another method of birth control such as condoms and seek medical attention.
• Panty liners and pads are encouraged over tampon use for the first 72 hours after insertion.
• The use of a Diva Cup® may increase the risk of IUD expulsion (falling out). If you use a Diva Cup® remember to break the suction before removing the cup.
• You can have sexual intercourse 48 hours after insertion, if you feel comfortable.
• Never attempt to remove an IUD yourself.

Preparing for the insertion day

• Take over-the-counter pain medication such as Ibuprofen or Naproxen before your appointment
• If you purchased a hormonal IUD at the pharmacy, remember to bring it with you to your appointment
• Make sure you eat a meal before your appointment
• Bring a pad with you to your appointment
• When you arrive at 179 Clarence Street enter the main doors and turn left.  The door to the clinic is locked.  Ring the doorbell and the receptionist will let you in.  
• Bring your Ontario Health Card (OHIP card), if you have one.  Otherwise, bring a form of photo ID.

Common Side Effects

• Most people feel discomfort during and after the procedure, discuss pain control options available with your healthcare provider. The cramps will lessen with time. Rest, mild heat to your abdomen and/or pain medication may help.
• It is normal to have some mild bleeding and spotting during the first few days after the insertion.
• After a hormonal IUD insertion, you can expect spotting and/or irregular bleeding for 3-6 months, then your period will usually decrease over time. If there is an abrupt change in your bleeding pattern such as very heavy bleeding or no bleeding, contact the clinic.
• A copper IUD may cause you to have longer or heavier periods with cramping. This may improve over time.
• Note: Heavy bleeding and clots (causing you to change pads every hour) could be a sign of a perforation and requires urgent follow-up at a hospital emergency department.

What is the external condom?

The external condom is a thin sheath that covers the penis. Most condoms are made of latex, although polyurethane, plastic and lambskin condoms are available. A variety of external condoms is available: plain or reservoir-tipped, dry or lubricated, straight or shaped, smooth or textured, natural or brightly colored and a variety of sizes. Free external condoms are available at the Sexual Health Centre and other community health centers. The external condom is 85-98% effective if used properly.

Types of external condoms

Latex condom

• Most popular
• Protects against sexually transmitted and blood borne infections (STBBIs)
• Can decrease the risk of pregnancy when used in combination with a birth control method

Polyurethane condom

• Stronger than the latex condom
• Transmits more body heat, allowing more sensitivity
• Can be used with oil-based lubricants
• Can be used by those who are sensitive or allergic to latex
• More expensive than latex condoms
• Provides protection against STBBIs and pregnancy similar to latex condoms

Lambskin condom

• Made from lamb’s intestines
• Not recommended for protection against STBBIs
• Can decrease the risk of pregnancy when used in combination with a birth control method

How does the external condom work?

The external condom acts as a barrier that prevents contact between bodily fluids (semen or vaginal secretions) and the sexual partner. The external condom protects against unintended pregnancy and STBBIs including HIV.

What can the external condom be used for?

For oral, vaginal and anal sex.

1. Check the expiry date.
2. Check the package (It should be sealed and not torn).
3. Put a drop of water-based lubricant or saliva in the tip of the condom for better sensation (oil-based lubricant can only be used with polyurethane condoms).
4. Leave a space at the tip of the condom for semen collection if the condom does not already have a reservoir at the tip.
5. If not circumcised, pull back the foreskin with one hand.
6. Pinch the air out of the tip.
7. Place the rolled condom over the tip of the erect penis.
8. Unroll the condom over the erect penis. Unroll it all the way down to the base of the penis.
9. Smooth out any air bubbles.
10. Apply lubricant outside of condom.
11. Remove the condom immediately after ejaculation (“cumming”). Hold the condom at the base of the penis while pulling out. Pull out before the penis softens.
12. Throw the condom in the trash.
13. Use a new condom every time you have sex or when you are sharing sex toys with your partner(s).

What are the advantages, possible side effects/problems of the external condom?

Advantages:

• Easily accessible and affordable.
• It can be used in combination with other methods of birth control.
• Can decrease the risk of pregnancy when used in combination with a birth control method.
• Latex and polyurethane condoms protect against most STBBIs including HIV.

Possible side effects/problems:

• Allergy to latex causing irritation
• Spermicidal condoms may cause irritation to the genitals
• Slippage or breakage
• Decreased sensation or loss of erection

What is the progestin-only pill?

The progestin-only pill (POP) is a pill taken by mouth every day at the same time to prevent pregnancy. The POP contains only one hormone: progestin. There are two available forms of POP: Drospirenone and Norethindrone.  

The POP changes the mucus in the cervix making it harder for sperm to enter the uterus, prevents the ovaries from releasing an egg each month (ovulation), and changes the lining of the uterus making it difficult for an egg to attach itself.

How do I use the POP?

Take one tablet daily. It is important to take your pill at the same time each day to avoid pregnancy. Try to take your POP with a scheduled activity such as a shower or breakfast. The POP is only available in a 28-day pack; take one pill every day for 28 days. Start a new pack of pills after completing the previous pack.

I forgot my pill.  What should I do?

If you miss a pill, follow the instructions included in your pill pack, or visit Stay on Schedule for more information.  

What are the advantages and possible side effects of the POP?

Advantages

• Decreased menstrual bleeding
• Decreased menstrual cramping and premenstrual symptoms

Possible side effects

These side effects will likely resolve within the first three months:

• Irregular bleeding
• Headache
• Bloating
• Acne
• Breast tenderness

The contraceptive patch, also known as the Evra® patch, is a birth control patch changed weekly and worn on the skin to prevent pregnancy. The patch contains two types of hormones, estrogen and progestin, which are taken in through the skin. It is 91% effective with typical use.

How does the contraceptive patch work?

The contraceptive patch prevents the ovaries from releasing an egg each month (ovulation). If there is no egg to meet the sperm, pregnancy will not occur. It also changes the lining of the uterus making it difficult for an egg to attach itself. Finally, the patch changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use the contraceptive patch?

How do I use the contraceptive patch? 

Each patch is worn on the skin for seven days. One patch is worn each week for 3 weeks. The patch should be changed on the same day each week. The fourth week is patch-free; your period should begin during the patch-free week.

• Apply to clean, dry and intact skin. To ensure that the patch sticks well on the skin, avoid using creams, lotions or other skin products around the patch area.
• To avoid skin irritation, apply the patch to a different area every time it is changed.
• Place the patch in one of four areas: the buttocks, the lower abdomen, the upper outer arm and upper back (shoulder blade area). Do not place on the breasts.
• Check patch daily to ensure it is well in place.
• The patch can be worn during all daily activities, including bathing and swimming.
• Do not cut, write on or change the patch in any way.
• Do not use other tapes or wraps to hold Evra® in place, even if the edges start to peel away from the skin.
• Note: Avoid spending a lot of time in saunas or hot tubs, as this could increase your exposure to estrogen.

It takes 7 days for the patch to start taking effect and prevent a pregnancy. Use a back-up method of birth control during this time to prevent a pregnancy, such as condoms or abstinence. If this is the first time you start the patch, it is best to use a back-up method for the first month, as you adjust to the routine of changing the patch weekly. 

What to do if the contraceptive patch partially or fully comes off

Less than 24 hours: re-apply it right away or apply a new patch, no backup method of birth control needed and your “patch change day” remains the same.

More than 24 hours: STOP the current cycle. Start a new cycle right away by applying a new patch and this is now day one of your cycle and your new “patch change day”. Use a back-up method of birth control if you have sex in the next seven days.

What are the advantages, possible side effects or complications of the contraceptive patch? 

Advantages:

• Convenient – once a week
• Decreased cramping and menstrual bleeding
• Improved cycle control
• Reduced risk of ovarian and endometrial cancer
• Can reduce acne

Possible side effects:

Slight possibility of:

• Irregular bleeding
• Nausea
• Headaches
• Sore breasts
• Local skin reaction, redness or itchiness on or around the patch area.

*Side effects will likely resolve within the first three months.

Possible complications:

People who have any of these symptoms while on the contraceptive patch should go to the hospital immediately:

• Abdominal pain (severe pain or lump in the abdomen).
• Chest pain or shortness of breath.
• Headache (severe) with dizziness, weakness or numbness.
• Eye problems (vision loss or blurred vision) or speech problems.
• Severe leg pain or numbness (calf or thigh).

I forgot to change my patch. What should I do?

Follow the instructions included in your package or visit Stay on Schedule for more information.  

Which week of your cycle did you forget to change the patch?

What is the vaginal contraceptive ring? 

The vaginal contraceptive ring, also known as the NuvaRing®, is a bendy, soft, one size fits all, silicone ring. The ring is inserted in the vagina and remains in place for 3 weeks at a time.  The vaginal ring contains two hormones, estrogen and progestin, which are absorbed through the walls of the vagina and then distributed in the blood. The vaginal ring does not require sizing or fitting and is 99.7 per cent effective if used the right way.

How does the vaginal ring work?

The vaginal ring prevents the ovaries from releasing an egg each month (ovulation). It also changes the lining of the uterus making it difficult for an egg to attach itself, and it changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use the vaginal ring?

Anyone seeking a reliable and reversible method of birth control that does not require daily attention.  It is important to consult a healthcare provider, as the vaginal ring should not be used if you have certain health conditions. 

How do I use the vaginal ring?

The vaginal ring is made to release a steady amount of hormones over a 21-day period followed by a seven-day ring-free period. Each ring is used for one cycle and then removed and discarded.

Insert a vaginal ring into your vagina and keep it in place for three weeks in a row. Remove the vaginal ring and after seven days, insert a new ring.  Your period should begin during the ring-free week. The vaginal ring should be left in place during sex and is usually not felt by either partner. It can be used with condoms and tampons.

• To insert: After washing your hands, squeeze the vaginal ring in the middle between the thumb and the index finger and insert it into the vagina as far as it will go. The exact placement is not important for the vaginal ring to work and the muscles of the vagina should keep the ring in place.
• To remove: Put a finger into the vagina and pull it out. Put the used ring in the foil pouch it came in and then in the garbage, not in the toilet. 

Backup?

What if it slips out?

On rare occasions, the vaginal ring can slip out. This can happen if the ring is not properly inserted, if you strain for bowel movements (stool) or sometimes during sex. 

If your vaginal ring slips out, follow the instructions included in your vaginal ring package, or visit Stay on Schedule for more information.  

What are the advantages, possible side effects or complications of the vaginal ring?

Advantages:

• Convenient, once a month and discreet
• Decreased cramping and menstrual bleeding
• Improved cycle control
• Reduced risk of ovarian and endometrial cancer
• Can reduce acne

Possible side effects (will likely resolve within the first three months):

• Irregular bleeding
• Nausea
• Headaches
• Sore breasts
• Vaginal irritation with whitish vaginal discharge

Possible complications:

Individuals who have any of these symptoms while on the vaginal ring should go to the hospital immediately:

Abdominal pain (severe pain or lump in the abdomen)

Chest pain or shortness of breath

Headache (severe) with dizziness, weakness or numbness

Eye problems (vision loss or blurred vision) or speech problems

Severe leg pain or numbness (calf or thigh) 

Emergency contraception consists of methods that can be used after unprotected sexual intercourse to prevent pregnancy. Emergency contraception is for occasional use; it is not a regular method of birth control.There are two methods of emergency contraception:

• Oral medication, also known as the “morning after pill”, taken within 5 days of unprotected intercourse:
  • Plan B® (levonorgestrel)
  • Ella® (ulipristal acetate)
  • Copper-IUD inserted within 7 days of unprotected intercourse

Plan B® (levonorgestrel) and Ella® (ulipristal acetate) are not abortion pills and will have no effect if you are already pregnant.

Who can use emergency contraception?

Almost everyone can use emergency contraception. Even an individual who cannot use birth control pills containing estrogen can use Plan B® (levonorgestrel) or Ella® (ulipristal acetate) because there is no estrogen in these medications. If you know or suspect, you are pregnant you should not use emergency contraception.

What is Plan B®(levonorgestrel)?

Plan B® contains the hormone progestin and works by delaying the release of an egg from the ovaries.

You can purchase Plan B® at most pharmacies without a prescription or at the Sexual Health Centre. Plan B® works best when taken as soon as possible after unprotected sexual contact, preferably within three days (72 hours) and has some effectiveness up to five days (120 hours) after unprotected sexual contact. Plan B® may not be as effective in individual with a BMI ≥25.

What is Ella® (ulipristal acetate)?

Ella® is a selective progesterone receptor modulator and acts on the body’s hormones to delay the release of an egg from the ovaries.

Ella® is available at most pharmacies, by prescription only. Ella® can be used for emergency contraception up to 5 days after unprotected intercourse. Ella® may not be as effective in individual with a BMI ≥35.

What are the advantages of oral emergency contraception?

• Oral emergency contraception is very safe and can be taken by almost everyone
• Oral emergency contraception will not cause harm if you are already pregnant

What is a copper IUD?

A copper IUD can be inserted within 7 days of unprotected intercourse. Please see the IUD fact sheet for further information or discuss with your health care provider.