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 - IUC

• IUCs are methods of birth control inserted inside the uterus (intra-uterine).
• The non- hormonal IUC is a small T-shaped plastic device with copper wire around it.
• The hormonal IUC contains one hormone called progestin.
• IUCs must be inserted by a health care professional (HCP), and are at least 99% effective in preventing pregnancy for five years.
• The copper IUC can also be used for emergency contraception if inserted within 7 days of unprotected sex.

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

• IUCs 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 IUC, 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 IUC you may purchase it at our clinic.
• IUCs can be inserted any time during your cycle provided pregnancy is ruled out.
• The copper IUC is effective immediately. The hormonal IUC (Kyleena or Mirena) is effective 7 days after insertion.
• Check your IUC strings. If you feel the plastic part of your IUC 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 Diva cups® may increase the risk of IUC expulsion (falling out). If you use a diva cup remember to break the suction before removing the cup.
• If you feel comfortable, you can have sexual intercourse 48 hours after insertion.
• Never attempt to remove an IUC yourself.

Preparing for the insertion day

• Bring your hormonal IUD to the clinic, it may take your pharmacy a few days to get this for you.
• Use OTC pain medication such as Ibuprofen or Naproxen before 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 St. please ensure you are wearing a mask. We ask that you come alone so we have room for proper distancing. The doors to the clinic are locked, but ring the bell and we will let you in.
• Please bring your Ontario Health Card (OHIP card)

Common Side Effects

• Most people feel discomfort during and after the procedure as your uterus adjusts to the IUC. 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.
• For hormonal IUC, 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 health care provider who inserted your IUC.
• For the copper IUC, you may have longer or heavier periods with cramping following insertion. 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 the emergency room.

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), also known as Micronor®, is a pill taken by mouth every day at the same time to prevent pregnancy. The POP contains only one hormone -progestin. The POP is 92 to 99.7 per cent effective if taken at the same time every day.

The POP changes the mucus in the cervix making it harder for sperm to enter the uterus. In some people, the POP 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?

Begin taking the POP on the first day of your period. 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. There is no hormone-free interval. Start a new pack of pills after completing the previous pack.

If you miss a pill, follow these directions:

If you miss a pill by more than three hours - take it as soon as you remember. Take the next pill at the regular time. This may mean you are taking two pills in one day. Use a backup method of birth control if you have sex in the next 48 hours.

If you miss two or more pills in a row - take two pills per day for two days. Use a backup method of birth control if you have sex in the next 48 hours.

If you have unprotected sex after a missed pill, you should use emergency contraception. 

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

Advantages

• Decreased menstrual bleeding
• No more periods (up to 10% of users)
• 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 Evra® patch contains two types of hormones, estrogen and progestin, which are taken in through the skin. The Evra® patch is 91% effective with typical use.

How does Evra® patch work?

The Evra® 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 Evra® patch?

How do I use the Evra® 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 Evra® 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 Evra® 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:

Women who have any of these symptoms while on the Evra® 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?

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, see-through ring about two inches (5 cm) wide. The NuvaRing® is inserted in the vagina and changed once a month to prevent pregnancy. The NuvaRing® contains two hormones - estrogen and progestin, which are absorbed through the walls of the vagina and then distributed in the blood. The NuvaRing® does not require sizing or fitting and is 99.7 per cent effective if used the right way.

How does the NuvaRing® work?

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

Who can use the NuvaRing®?

Persons seeking a reliable and reversible method of birth control that does not require daily attention. 

How do I use the NuvaRing®?

The NuvaRing® is made to release a steady amount of hormones over a 21-day period with a seven-day ring-free period. Each ring is used for one cycle and then removed.

Insert a NuvaRing® into your vagina between day one and day five of your period and keep it in place for three weeks in a row. Remove the Nuvaring® for a seven-day break after which you will insert a new ring. Your period should begin during the ring-free week. The Nuvaring® should be left in place during sex and is usually not felt by either partner. It can be used with a condom and tampons.

• To insert: After washing your hands, squeeze NuvaRing® 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 NuvaRing® 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. Dispose of the used ring in the foil pouch it came in, but not in the toilet. 

Backup?

What if it slips out?

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

Out for less than three hours:

• The ring should be rinsed with cool-to-lukewarm (not hot) water and re-inserted as soon as possible (within three hours).
• You should still be protected against pregnancy. No backup method of birth control is needed.
• If NuvaRing® is lost, you should insert a new ring and stay on the same schedule.

Out for more than three hours:

• You may not be protected against pregnancy.
• During week 1 and 2: The ring should be rinsed with cool-to-lukewarm (not hot) water and re-inserted as soon as possible. You must use a backup method of birth control until the ring has been in place for seven days in a row.
• During week 3: The ring should be discarded and a new ring should be inserted.  This will start a new 3-week cycle.  You may not experience a period, however, some spotting or bleeding may occur.  You must use a backup method of birth control until the ring has been in place for seven days in a row.

What are the advantages, possible side effects or complications of the NuvaRing®?

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 NuvaRing® 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.