If you’re a straight woman in America, there’s a 98% chance you’ve used one form of birth control or another. There are about a million (ok, not a million, there about 9 major different) options when it comes to birth control, or, how I like to talk about it, fertility management. You have fertility? Let’s manage that shit and make it do what you want until you want it to do something else. If you want it to do something else.
I love talking about birth control. I love talking about it so much that the physicians that work in the same office that I do will sometimes pull me into a room to go over a woman’s birth control options with her, because they either a) know how god damn happy it makes me to talk about it, or, the more likely b) they don’t have time, and they want to give me something to do.
So, what are your options?
1) Plain ol’ birth control pills like your mamma used to take. Many women that I talk to still think that this is pretty much their only option. Also, there are about a million (this time, yes, about a million. Ok, more like 50) different formulations of estrogen-progesterone based pill methods. You want to know how I chose which one to start you on? I have a handy dandy little book with beautiful flow-charts and infographics. But mostly it’s whatever is on the $4 Walmart drug list.
2) Patches. Also estrogen-progesterone, but looks like a little tan square that you put right on your person.
3) The Ring. No. Not the movie. This one goes in the vagina. I have a little model and sample of that the ring looks like, and I absolutely love the shocked/disgusted/curious looks I get from patients while showing them. When I act things out in clinic, I get really into it, and patients probably don’t appreciate me spreading my legs and pretending to insert the device myself, but hey, I’m a big fan of demonstrations).
4) The Mini-Pill. This pill is not just a small version of the other ones, it’s just progesterone based, and perfect perfect perfect for breast feeding mammas! Although it has to be taken within the same 3 hour window every. single. day. if you want it to be effective. No joke. Set an alarm for that shit.
5) IUDs. These are literally my favorite. I should probably be hired by Mirena or Paraguard to hock these tiny t-shaped devices that sit at the top of your uterus and ward off pesky fetuses for 5 and 10-12 years, respectively. I’m a walking advertisement for them not only because they are WAY cheaper in the long run, but they are the most effective form of birth control you can chose short of abstinence. (But, we also must remember, as one of my dear friends has reminded me, it’s only 99.99% effective.) Some women are skeeved out by the IUD because it goes inside the uterus, and let’s be honest, as someone who had a diffucult IUD placement, I feel ya. Some women are scared it’ll get in there and then swim away, never to be found again. To this, I give (yet another) very animated demonstration on how to check your own IUD strings. ( You can try finding your cervix sitting! Standing! Squatting! One leg on a chair! Aim down and back! It feels like the tip of your nose, now find the strings that feel like fishing wire!) Also, sometimes, we get women that come back stating that their partner is pissed because he can feel the strings. To this I say: Suck it up, dudes. IUDs are awesome.
6) The Nexplanon. This comic pretty much sums it up. And is too genius to add anything to. I’m seriously considering printing it out and giving it to patients once I’m in independent practice.
7) Barrier methods: Condoms! Diaphragms! Cervical Caps! Always a great option, but unfortunately, all of them involve erm….interrupting the act in order to use. Not a great option for everyone for long term use, but for the moderately monogamous, diaphragms and cervical caps are great. And let’s not kid, condoms are great for the long-term monogamous couple and the casual fuck alike! So versatile!
8) Coitus interruptus. Midwife’s advice: Don’t use this method unless you want to see me for a pregnancy. For which I will give you comprehensive, shame-free counseling (A post on being a radically pro-choice midwife is in the works).
9) Natural Family Planning. Lots of my patients have used this method for years, along with lactational amenorrhea with great success. For anyone considering NFP, I highly recommend the awesome book Taking Charge of Your Fertility.
I love talking about birth control not only because I have a personal fascination with it, but also because it can be a frustrating thing for a woman to try and find a birth control method that works for her. Many women come to me in their teens, either having sex already or wanting to have sex, and have never had a conversation with their parent or guardian about what their options are. Just like I love doing young women’s first pelvic exams, and gently introduce them into what will hopefully be a wonderful relationship with their bodies and women’s health care, I hope to encourage young women to find a birth control that they like, are excited about, and will use so they can truly take charge of their fertility!