A Simple Guide to Birth Control

Birth control has been the key to the modern era, to the liberation of women.  In the pre-birth control era, a woman with a sexual partner could expect an 85% chance of pregnancy in ANY GIVEN YEAR.   Imagine attempting to get an education, to build a career, to live your own life when constantly interrupted by the exquisitely messy apocalypse that is child birth.   Yet, in a phenomenon that crosses all economic brackets (although localizes heavily to young people of all types), birth control is fundamentally misunderstood.  The mythology and mysticism that surrounds a medication over 50 years old at its root is almost perplexing.   Even my most intelligent and well-informed female friends, women who handled law school and big business like they were playground games, struggle to stay fully abreast of their reproductive options.  American's in particular are terrible at planning pregnancy, with a rate of unplanned conception almost 20 percentage points higher than our Canadian neighbors.   

Accordingly, as a public service, I wanted to create a simple list of contraception, an encapsulation of current information about the available types (at least any that should ever be used).  DISCLAIMER:  none of these methods protects from STDs.  ONLY CONDOMS PROTECT FROM STDS.   Thank you.  Second disclaimer:  this list is grossly simplified.  I only include key points.  Please follow up with your health care provider, but if you have an asshole for a doctor who doesn't want to inform you of your options, planned parenthood is a wonderful resource.      

1) THE PILL!   Classic Style 

Efficacy: 0.8% failure rate when used appropriately (8% in actual use) 

Pros:  decreases odds of many forms of cancer (endometrial, ovarian), decreases odds of pregnancy when used appropriately (1 pill/day, hiatus period, don't miss any days).   

Cons: You can't smoke.  (thats not really a con medically, but for some), you have to take it reliably.  Cannot take if you have migraines.   

Myth: OCP causes cancer:  mostly false.  there is an increase in breast cancer, but a larger decrease in ovarian and endometrial.  overall, decreases cancer.   

2) IUD:  Uterine Border Patrol:

the intrauterine device is a marvel of medical engineering.   The choice of almost all female practitioners I know, the IUD, my friends, is the best thing short of not ever getting laid for not getting knocked up.   

Efficacy: 0.3% failure rate/year

Pros: one insertion, and you can forget about it for 5-10 years.  Less estrogen exposure means less increased thromboembolic risk.   Tends to decrease periods to almost nonexistence.    

Cons: insertion can be painful, a small fraction of women get abdominal cramping and pain for 3-6 months after insertion.   Increases the risk of pelvic inflammatory disease (from gonorrhea and chlamydia), so don't sleep around.   

Myths: the IUD has spawned a myriad of myths.  The first launch of the product in the 80's tended to cause sterility.  This is a phenomenon of the past.   The IUD is as reversible as any product (assuming no PID).   Second, there is a myth that this product works by "stabbing infants"   IUD's work by preventing conception, blocking sperm from getting where they are going via some complicated biological remodeling that is not worth discussion.   Let me just reassure you:  In all studies, no fetus has ever been found "stabbed" by an IUD.  in fact, no fetus has ever been found in a uterus with an IUD.  IUDs fail by falling out.    This is NOT an aborting agent.   

3) Nuvaring:  If you like it, you better put a ring on it.   

Efficacy: 0.8% failure rate/year.  

Pros: easy to use, very effective.  

Cons: vaginal discharge, awkward insertion.   

Myth: partners can feel it:  FALSE.  very rarely can partners feel the ring.  Unless your partner is wearing Magnum condoms (for good reason), this is extremely unlikely.   It also does not fall out with sex.   

4) Injections:  Baby Immunization

efficacy: 0.5% failure/year

Pro: You only have to show up for a shot.   

Con: you have to get a shot!  but seriously, progestin only medication has several serious side effects, and Depo Provera should only be used for approximately 2 years straight.    

5) The patch:

I don't like the patch.  Don't use it.  

6) Anything else:  any other contraceptive (except condoms and variants of things described above) is NOT WORTH YOUR MONEY OR YOUR BODY.