Ask A Midwife: Taking Control of Your Birth Control

Ask A Midwife is a blog series from Adriatica Women’s Health. Hear directly from midwives on topics such as c-section risk, considering a VBAC, pregnancy in a pandemic and more.

This conversation about contraception with Angela Judson, a Certified Nurse Midwife, explains the different types of birth control available to you, their effectiveness as well as the benefits beyond preventing pregnancy.

Ashley: What are the different types of contraceptives and how effective are they? 

Angela: There’s a variety of birth control widely accessible. It’s important to find one that best suits your body. There is:

  • Male and Female Sterilization: tubal ligation for women and vasectomy for men. Both are permanent surgical procedures which are >99%effective.
  • Long-Acting Contraception (LARC): these include intrauterine devices (IUDs) and hormonal implants, which last three to ten years depending on which method you choose. LARCs are 99.2-99.8% effective and can be removed at any time. Over time they’re 20% more effective than pills, patches, or vaginal rings.
    • Examples include:
      • Skyla: 3-year progestin IUD
      • Nexplanon: 3-year hormonal implant
      • Kyleena: 5-year progestin IUD
      • Mirena or liletta: 6-year progestin IUD
      • Copper IUD (non-hormonal): 10 years
    • Short Acting Hormonal Options: up to 99% effective if used correctly.
      • Examples include:
        • Combined oral contraceptives: taken daily (91%)
        • Progestin-only pill (Minipill): taken daily (91%)
        • Patch: weekly transdermal patch (91%)
        • Vaginal ring: placed monthly (91%)
        • Shot: 3-month injection (94%)
    • Barrier Methods: must be used each time you have sex.
      • Examples include:
        • Condoms: male or female (79%-86%)
        • Diaphragms (88%) and cervical caps (77-83%). must be fitted/prescribed by healthcare professionals
        • Spermicide (72%)
        • Sponge (76%-88%)
        • Natural Rhythm Methods (76%) or withdrawal methods (78%)

Ashley: Where can the different kinds of contraceptives be purchased and are they generally covered by health insurance? 

Angela: You need a prescription from your healthcare provider for oral contraceptives, patches, vaginal rings, diaphragms, cervical caps, shots, IUDs, and implants. Condoms, spermicides, and sponges can be purchased at any local pharmacy.

Most insurances provide birth control coverage, but you should check with your insurance company for specific coverage. There are many options for low-cost birth control without insurance as well.

Ashley: How long does it take for birth control pills to be effective after you begin taking them?

Angela: Birth control pills are effective immediately if started within five days of the first day of your period or after seven if started at a different time.

Ashley: Can I have sex without a condom the day I start hormonal birth control?

Angela: Even though birth control is effective immediately if started within five days of the first day of your menstrual cycle, keep in mind that condoms should be used for prevention of STIs.

Ashley: What non-hormonal birth control methods are there and how effective are they? 

Angela: Birth control ranges in effectiveness and depends on whether you use the method perfectly or not.

Birth control effectiveness has many factors that influence how well it prevents pregnancy. There’s a percentage of efficacy for perfect use and a different percentage for how it’s usually used. Perfect use of a birth control pill is to take at the exact same time every day without ever varying from that time. The further away from that time the less effective it becomes. So, birth control pills are 99% effective with perfect use but 91% based on typical use. There are higher rates of pregnancy prevention in long-acting contraception because there is no user variation.

  • Copper IUD (ParaGard)
    • Is the most effective non-hormonal birth control as it’s over 99% effective.
    • No user error because it’s placed by a healthcare provider and doesn’t require action once it’s placed.
  • The Female Condom
    • Perfect Use
      • 95%
    • Typical Use
      • 79%
  • The Male Condom
    • Perfect Use
      • 98%
    • Typical Use
      • 86%
  • The Sponge
    • Perfect Use
      • 91%
    • Typical Use
      • 80%
  • Diaphragm
    • Perfect Use
      • 96%
    • Typical Use
      • 88%
  • Cervical caps are 86% effective before giving birth and 71% after giving birth.
  • Tubal ligation and vasectomy are 99% effective.
  • Spermicides alone are 72% effective at preventing pregnancy.

Ashley: What are natural forms of birth control and how effective are they?

Angela: Fertility awareness-based methods require abstaining from sexual intercourse or using condoms to prevent pregnancy during your most fertile times. These methods are around 75% effective at preventing pregnancy the way they are typically used.

Ashley: Do you still need to wear a condom if you have an IUD?

Angela: The IUD is extremely effective at preventing pregnancy but does not protect against sexually transmitted infections. You need to continue to use condoms to prevent STIs.

Ashley: Can contraceptives protect against STIs and STDs?

Angela: The best way to prevent STIs is to use condoms every time you have sex. The best way to prevent pregnancy and STIs is to use another form of birth control like the pill, patch, ring or LARC as well as condoms.

Ashley: What are female condoms and how are they used?

Angela: Female condoms are fitted inside the vagina. There is a closed end that’s inserted inside and a ring that stays outside of the vagina. You should not use both male and female condoms at the same time as they can easily tear.

Ashley: How do I find the best contraceptive for me and my body?

Angela: The best form of contraceptive for you is the one that you will use and are most comfortable with. I recommend talking with your healthcare provider to help you decide on the best option for you.

Ashley: Can you only get pregnant when you’re ovulating?

Angela: You can become pregnant three to five days prior to ovulation until one day after. An egg survives 24 hours in the fallopian tube and sperm can survive 3-5 days inside a woman’s body after intercourse. You are the most fertile when the sperm is present when ovulation occurs.

Ashley: Can taking hormonal birth control cause infertility?                                               

Angela: Taking hormonal birth control doesn’t cause infertility no matter how long you’ve taken it or which method you have chosen.

Ashley: How do I know if I’m pregnant if my birth control causes me to not bleed during my period?                                                                                                                               

Angela: It’s ok not to have a period on hormonal birth control. You may worry that you wouldn’t know if you become pregnant while taking birth control if you are not having a period. You should be aware of other early signs of pregnancy like sudden breast tenderness or nausea. If you suspect you’re pregnant, you should take a pregnancy test.

Ashley: What are the benefits of contraceptives beyond preventing pregnancy?            

Angela: Hormonal birth control may make your periods more regular, lighter, shorter, and help decrease menstrual cramps. There’s also a decreased risk of uterine, endometrial, ovarian, and colon cancer associated with using birth control. Birth control’s beneficial in treating polycystic ovarian syndrome, endometriosis, heavy bleeding and painful periods. It may also help improve acne and reduce unwanted hair growth.

Ashley: Is it safe to take two hormonal pills in one day?                                                              

Angela: Yes, there are a few reasons your healthcare provider may advise you to take more than one pill in a day. One reason is if you miss a pill, you should take it as soon as you remember. This could mean you would take two in the same day.

Ashley:  What’s the difference between emergency contraception and contraception in general? 

Angela: Emergency contraception reduces the chance of pregnancy after unprotected sex or birth control failure. Emergency contraception would be used if a condom breaks or slips off. Progestin-only pills for emergency contraception are available without a prescription.  Meanwhile, contraception is used regularly to prevent pregnancy.

Ashley:  Does emergency contraception cause abortion?                                               

Angela: Emergency contraception does not cause abortion. It prevents pregnancy from happening and must be used soon after unprotected sex to be effective. An abortion ends a pregnancy that has already occurred. All forms of emergency contraception should be used within five days of unprotected intercourse, as it won’t work if a pregnancy has already occurred.

Click the links to learn more about Angela Judson and Adriatica Women’s Health. Then, use our contact form to ask any women’s health questions you may have.