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11 birth control questions—answered
Drug Info

11 birth control questions—answered

Ninety-nine percent of sexually active American women report using some form of contraceptive, according to statistics released earlier this year from Yale Medicine. Precisely because it’s so common, it’s crucial to clear up the rumors, misconceptions, and birth control myths. 

When women choose a contraceptive method, preconceptions about different forms influence their decision. And most of us have heard some sort of negative information—such as birth control makes you gain weight. Or, it increases cancer risks and can affect fertility down the line. Some people even say that hormones make you “crazy.”

If you’re researching where to start, it’s easy to fall into a Reddit black hole about bad experiences and horror stories. Then, to read rave reviews about the same contraception on other forums. Choosing among the many options available—one that’s a good fit for your lifestyle and personal health shouldn’t be harder than it already is.

It’s time to get the real scoop on the benefits, side effects, risks, and effectiveness of birth control. 

Common birth control questions

Here, find answers to the most frequently asked birth control questions, so you can have the information you need when it comes to contraceptives—and none of the fears that you don’t.

1. Does hormonal birth control make me gain weight?

“The short answer is no,” says says Jen Kaiser,  MD, an assistant professor of family planning at the University of Utah. “In large pool studies we don’t see increases in weight in comparison to what you would naturally gain from the slowing of the metabolism and aging.” So, that means that for most women, birth control pills, vaginal rings and contraceptive skin patches are very unlikely to affect weight. Let’s repeat: Hormonal birth control is very unlikely to cause you to gain weight. This is straight from a doctor’s mouth and one of the most comprehensive (and updated) scientific studies, published in the National Center for Biotechnology Information. In about 5% of patients, there can be a retention of fluid while on birth control, also called edema. This can lead to small fluctuations in weight.

2. Can I only get pregnant one day a month?

If you have a regular period, your body releases one egg, on one day each month. But the window when you can get pregnant is much longer than 24 hours. An egg is only available to be fertilized for about 12 to 24 hours after ovulation, according to the American Pregnancy Association. But, sperm can live in the body for 3-5 days after sex. Add that to the day the egg is available, your most fertile window rises to approximately 5-7 days. In other words, you can get pregnant for about a week. 

Natural Cycles is an FDA-approved app that allows users to track their ovulation cycles. It’s a hormone-free way to better understand when you can—and probably aren’t likely to—get pregnant throughout the month. The app tells users daily whether it’s a “green” day, or “red” day of the month. On red days, users are more likely to become pregnant and should use a condom or abstain from sex to prevent unplanned pregnancy.  It’s 98 percent effective as a contraceptive with perfect use, and 93 percent effective with typical use. 

3. Can I have sex without a condom the day I start on hormonal birth control? 

Not if you want the assurance of not getting pregnant. It can take up to a week for your new form of birth control to become fully effective—depending on what kind of contraceptive you choose (a pill, IUD, implant, or Depo-provera shot) and where you currently are in your cycle. It’s best to use condoms for seven days after starting the pill, or getting an implant, IUD, or shot—then you’ll be in the clear. 

The copper IUD is a special case. It becomes effective immediately, according to Planned Parenthood. And remember, only condoms can protect against STDs and STIs.

4. Do copper IUDs make your period worse?

Paragard, the only copper IUD approved by the FDA and available in the U.S., has a few benefits that users like: It’s non-hormonal, it lasts for up to 10 years, it can be used while breastfeeding, and it can be used for emergency contraception if inserted within five days after unprotected sex. But according to the Mayo Clinic, the side effects associated with Paragard include bleeding between periods, cramps, severe menstrual pain, and heavy bleeding. Because of this, a copper IUD may not be the best fit for some women.

5. Can using hormonal birth control cause infertility?

You might’ve heard that years of taking the pill, having an implant, or a long-term IUD will make it difficult to get pregnant when you’re ready—but that’s just a myth. These methods of contraception only interfere with fertility when they are in use. 

“No forms of birth control decrease your ability of getting pregnant when you discontinue, no matter how long you use birth control,” says Dr. Kaiser. “Your ability to get pregnant goes back to whatever it was before birth control. That means if you had a high chance of getting pregnant, you still will. If you had a low chance, it goes back to being a low chance. The most important factor in your ability to get pregnant is age. If you try to get pregnant at 40, that will be harder than when you’re 26.” 

6. Should I have a period every month—even if I’m on birth control?

The Mirena and Skyla IUDs can lessen the number of periods you have, or stop them altogether. The implant, the pill (when used a certain way), and shot can also prevent you from having a period. And the fact of the matter is, it’s completely okay and safe to not have a period because of your birth control methods. 

Your body only needs to menstruate when there is the possibility of pregnancy, according to Planned Parenthood. Hormonal birth control prevents ovulation and stops the uterine lining from building up. The bleeding you experience in between pill packs or Nuvarings is withdrawal bleeding, a response to a gap in the hormones, not something your body requires. 

7. Can I lose my IUD?

You can—an IUD can fall out (this is called expulsion), or move to a place it doesn’t belong (this is called perforation). These are two risks you must consider when choosing copper or hormonal IUD, such as Mirena or Kyleena as your contraception, according to the Comprehensive Women’s Health Center of Colorado

Expulsion can happen naturally, but it’s not common. It occurs in only about 3% of IUD uses. Perforation, when your IUD pushes into or through the muscle of the uterus, is the rarest complication, occurring in only one or two of every 1,000 IUD insertions. It’s also the most dangerous. There have been very few cases where an IUD migrated to areas of the pelvis, abdominal cavity, gastrointestinal tract and bladder. If the IUD does move outside the uterus, the IUD must be surgically removed.  

8. Do I have to take my birth control pill at the exact same time every day?

Yes, you should. Though how important this is depends on what type of pill you’re taking. There are two types of commonly-prescribed contraceptive pills—the combined oral contraceptive pill (COC) and the “mini pill,” or progestin-only pill (POP). The COC prevents ovulation, so there is more room for error. 

However, 40 percent of women still ovulate while taking the mini pill, according to the American College of Obstetricians and Gynecologists (ACOG). The mini pill’s active ingredients only thicken the cervical mucus and the uterine lining for 24 hours at a time. So, it’s critical (and time-sensitive) to have another dose within that period. 

Both methods require consistent use to be most effective, so it’s best to stay on a schedule to avoid missing or forgetting your daily dose. Also important? Checking with your prescriber or pharmacist to see how your birth control may affect your other medications. Some drugs, like certain antibiotics or anti-seizure medications, have a strong potential to affection absorption of oral contraceptives. And certain anticoagulant drugs have a very dangerous interaction with hormonal birth control.

9. Is there one best kind of birth control?

No. “The best kind of birth control is the kind that works for you,” Dr. Kaiser says. There is no best form or overall winner for everyone when it comes to birth control. Each woman has to decide what works best for her, her lifestyle, and her body. Sitting down and chatting with a women’s health specialist, OB/gynecologist, or your primary care doctor can help you narrow down your options.

10. Can the pill cause cancer?

This is a myth—kind of.  So far, researchers have found that because oral contraceptives contain man-made versions of the female sex hormones estrogen and progesterone, changes in hormone levels may trigger breast cancer, but can also protect against ovarian and uterine cancer.  “Comprehensive studies have shown that birth control is shown to decrease the chances of uterine and ovarian cancer,” Dr. Kaiser explains. 

“But there is a little bit of a risk as far as breast cancer is concerned,” she goes on to say. “A Danish cohort conducted a pool study of thousands of women and found that birth control may minimally increase the risk for breast cancer. It’s a very small but increased risk that has not been borne out by any other large pool study in our field. I tell my patients that it’s something to be mindful about, but as medical professionals, we don’t put too much weight on it yet.”

11. Will hormonal birth control affect my emotions?

Maybe, but it’s a case-by-case basis, and the science is conflicted. A study of over a million Danish women over age 14—using credible and constructive data such as diagnosis codes and prescription records—strongly suggests that there is an increased risk of depression associated with all types of hormonal contraception. But that’s not the full story. 

“We don’t see a strong correlation between birth control and mood swings play out in most big studies, but if a patient is worried about mood swings or effects on their mental health, there are options that have little or no hormones. It’s not common, but I’ve seen patients who have experienced impacts and effects from their contraceptive with  their depression. If you’re worried about emotional changes, I encourage patients to partner with their primary doctor or medical professional to find a non-hormonal solution.” 

If you have a history of depression, or if hormonal birth control isn’t right for you, there are many other options—from the copper IUD to the Natural Cycles app—that can help put your reproductive choices back in your hands.

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