Busting Myths and Stating Facts about Birth Control
Oral contraceptives (the Pill) are hormonally active pills that are usually taken by women daily. They contain either two hormones combined (progestogen and estrogen) or a single hormone (progestogen). Combined oral contraceptives suppress ovulation. Progestogen-only contraceptives also suppress ovulation in about half of women (they are slightly less effective). Both types cause a thickening of the cervical mucus, blocking sperm penetration.
Oral contraceptives are 92 – 99% effective. A woman can decide to start taking the pill if she is sexually active or planning to become sexually active and is certain she is not pregnant. Some pills are taken daily for 21 days and stopped for 7 days before starting a new package. Other kinds are taken continuously for 28-day cycles. Oral contraceptives should be taken in order, at a convenient and consistent time each day. They are appropriate for women who are willing to use a method that requires action daily and who will be able to obtain supplies on a continuous basis.
The pill offers continuous protection against pregnancy, it produces regular and shorter periods (and frequently a decrease in menstrual cramps), and it protects against ovarian and endometrial cancer, ectopic pregnancies and infections of the fallopian tubes.
Possible side effects include nausea, breast tenderness, mild headaches, and weight gain, or loss. Very rarely, it can lead to serious health risks (e.g. blood clots, heart attack, and stroke). Risks are higher for women over 35 years who smoke.
The pill does NOT protect against sexually transmitted infections (STIs, including HIV). To protect against STIs, a male or female condom must be used.
Myth: Hormonal methods are the only option
Fact: People often take the term birth control to mean hormonal forms of birth control, such as birth control pills, patches, implants, or the hormonal intrauterine device (IUD). However, hormonal birth control is just one option among many. Some people choose not to use or must avoid hormonal methods, so they can choose from a variety of alternative methods. Some other methods of birth control are equally, if not more effective than hormonal options. The copper intrauterine device (IUD), for instance, contains no hormones and is 99% effective – more effective than the pill. When used correctly, breastfeeding may be an even more effective contraceptive than some hormonal methods. Those who are breastfeeding may choose this method of birth control rather than hormonal types immediately after childbirth.
Myth: Birth control causes cancer
Fact: Another common misconception is that birth control pills cause cancer. It is true that birth control may slightly elevate the risk of some types of cancer, particularly breast cancer and cervical cancer. One 2010 study, for instance, found a slight increase in breast cancer rates among women who had used oral contraceptives. The overall risk remained low. However, most of the increased risk was among women who used a triphasic pill, which uses three different doses of hormones during a woman’s cycle. The risk may be lower with other types of pills. Additionally, because the study was prospective, it could not control for all other risk factors. However, birth control pills can also lower the risk of other cancer types. While research generally points to a slight increase in breast and cervical cancers, hormonal birth control may lower the risk of:
- Endometrial cancer
- Ovarian cancer
- Colorectal cancer
Myth: Natural methods do not work
Fact: Lifestyle-based methods of birth control might be more difficult for a person to implement correctly, which is why some people believe they do not work at all. Fertility awareness is one form of natural birth control that can be effective if a person does it correctly. It involves a person diligently monitoring their body temperature, observing daily changes in their cervical mucus, and knowing exactly when their period is due.
Breastfeeding can also be an effective birth control method. However, a person must breastfeed the baby during the first 6 months of its life, give the baby few or no other foods, and must not yet have had a period. This is called the lactational amenorrhea method (LAM).
Any prolonged periods without breastfeeding will increase the odds of pregnancy significantly. If the baby drinks formula or eats other foods, ovulation will begin again, and a period will follow. Even the controversial withdrawal method, which involves “pulling out” before ejaculation, is 78% effective with consistent, correct use. But for many, a 22% chance of getting pregnant (more than 1 in 5 chance) is way too high. People who choose this method may incorporate other methods to increase effectiveness.
People may wish to keep emergency contraception (such as the morning-after pill) at home just in case their partner does not withdraw in time, and semen gets into the vagina. Emergency contraception pills are effective for up to 5 days after having sex.
Myth: Birth control can prevent STIs
Fact: Barrier methods, such as condoms, can reduce the risk of transmitting many sexually transmitted infections (STIs). However, these methods cannot prevent all STIs, and there is no safe way to have sex with someone you know has a STI. Herpes ,for example, can live on parts of the genitals that condoms do not cover. Any birth control method that does not create a barrier between people’s bodies cannot prevent STIs. Hormonal birth control, permanent sterilization, fertility awareness, IUDs, and other methods still allow STIs to spread from one partner to the other during sex.
Myth: Hormonal types cause abortions
Fact: Some anti-abortion groups have expanded their focus to include contraceptives, especially hormonal birth control.
Birth control cannot cause abortions. This is because all forms of hormonal birth control work by preventing ovulation, and ovulation prevents implantation. Implantation is the beginning of pregnancy.
Myth: Birth control causes weight gain
Fact: While many people worry that hormonal contraceptives cause weight gain, numerous studies have shown either that birth control does not cause weight gain, or that the average user gains only a few pounds.
A 2014 study that looked at both participants at a moderate weight and those with obesity found no significant change in body weight or composition after using oral contraceptives.
A 2016 Cochrane review of 22 previous studies found little or no evidence of weight gain. Even among studies that did show slight increases in weight, the average weight gain was only 4.4 pounds. The 2016 review looked exclusively at progestin-only pills, which offer a lower dose of hormones. This suggests that people concerned about weight gain may prefer to use low-dose pills.
Myth: Birth control damages fertility
Fact: It can take a few months for a person’s menstrual cycle to return to normal following the use of hormonal birth control, including IUDs, the pill, the patch, and the implant. However, there is no evidence that hormonal contraceptives affect fertility over the long term.
A 2011 study compared pregnancy rates following the use of various forms of hormonal birth control. Overall, pregnancy rates were similar among previous users of birth control and those who had never used it.
Infertility is common, especially as people age. About 12–13% of couples have trouble getting pregnant. Fertility difficulties after birth control do not mean birth control causes infertility.
Myth: Older people do not need birth control
Fact: Some people think they cannot get pregnant because they are older or their periods are irregular. Until a person has gone through menopause and had 12 consecutive months without a period, pregnancy is still possible.
While male fertility also declines with age, males can remain fertile well into their 60s, 70s, and beyond.
The risk of congenital abnormalities and other complications increases with the man’s age, however.
Myth: The morning-after pill is like an abortion
Fact: Emergency contraceptive pills, also known as the morning-after pill or Plan B, are high-dose birth control pills that prevent pregnancy after a person has had sex without using birth control.
Taking a morning-after pill is not the same as having an abortion. An abortion is a procedure that interrupts an established pregnancy. Emergency contraception reduces the need for a later abortion due to an unplanned pregnancy.
Initially, researchers thought that the morning-after pill worked in two ways: by delaying or preventing ovulation, and by reducing the chances of an egg implanting during ovulation and a sperm fertilizing the egg. Currently, researchers only have evidence that it delays ovulation, preventing the egg from being released and fertilized.
Because an abortion pill is also available, some people confuse emergency contraception with this drug. Moreover, some anti-contraceptive groups promote the idea that the morning-after pill causes an abortion.
Emergency contraception does not and cannot cause an abortion. It does not end a pregnancy but prevents it from occurring in the first place.
Myth: Birth control causes blood clots and stroke
Fact: Hormonal birth control can carry some risks, but these risks usually do not apply to everyone. Some people have specific risk factors that make them more likely to develop complications from birth control. For example, in people over the age of 35 who smoke and people with a history of cardiovascular disease, hormonal birth control may increase the risk of blood clots and stroke.
People with obesity and those with certain types of migraines should also speak to a doctor about their risk of blood clots and stroke. For these people, a doctor can prescribe birth control that does not contain estrogen or recommend a non-hormonal option.
Most people can find a safe birth control option for them. Even when there are risks, the chances of pregnancy can sometimes be higher.
Most people can find a safe birth control option for them. Sometimes a person has to try several methods or a combination of methods to find something that is convenient and causes the fewest side effects. And while all medications, including birth control, carry some risks, most myths about the dangers of birth control are untrue. Anyone considering using a new type of birth control can ask a doctor or other trusted health professional about proper use.