Consider all your contraception questions officially answered! Our medical experts weigh in on your urgent, awkward, and even embarrassing birth control dilemmas.
Birth control slip-ups, effectiveness, and troubleshooting
If I'm on the ring or the patch and forget to replace it on the right day, do I need to use backup?
While clinical trials have shown that you may have one or two days of leeway, experts suggest taking extra precautions. "The safest course of action is to use a backup method of birth control for seven days if you're more than a day late replacing your patch or ring," says Vanessa Cullins, MD, Vice President for External Medical Affairs at Planned Parenthood. If you slip up and have unprotected sex during those seven days, you may want to take emergency contraception as a backup. It's safe to take EC while also on the ring or patch, but you may experience more side effects—like nausea or vomiting—than you would if you weren't on hormonal birth control, says Cullins.
In this case, your primary birth control method should offer up enough protection. "The pill is already approximately 99 percent effective when taken correctly," says Alyssa Dweck, MD, coauthor of V is For Vagina. "I suppose withdrawal can't curt, but it gives minimal additional protection." If you're really looking to double up on protection, use a condom along with the birth control pill.
Whether you take the Pill or not, you should always wear a condom to protect against STDs if you are not in a monogamous relationship or if you haven't both been tested.
Is asking my guy to pull out a reliable method of birth control?
The withdrawal method, or "pulling out," isn't the most effective way to prevent pregnancy—and it offers zero protection against sexually transmitted diseases. According to a 2008 study in the journal Contracption, the failure rate for withdrawal (the percentage of people who got pregnant while using this method in a given year) is about 18%, while the failure rate for the pill and condoms is 1% and 2% respectively (with perfect use). "It's not as bad as you might think, but it also depends on how good your withdrawal [timing] is," says Dweck. Another issue: your guy's pre-ejaculate also contains sperm, and that can be released before he pulls out. So if you're truly serious about preventing pregnancy, stick with a more reliable method like the pill, the IUD, or condoms. If you're in a pinch, withdrawal is certainly better than nothing, says Cullins, though we still wouldn't suggest it as your primary birth control method.
What should I do if the condom breaks or slips off inside me?
First make sure to remove the broken or lost condom by feeling around with your fingers, hooking a finger onto the latex, and pulling it out, says Dweck. If you're worried about pregnancy prevention, you'll also want to get emergency contraception as soon as possible, says Dweck. Emergency contraception, like Plan B, is effective at preventing pregnancy when taken up to 72 hours after unprotected sex. But it decreases in effectiveness after that, so the sooner you get it, the better chance you'll have at preventing pregnancy. Finally, check with your doctor within a week to be tested for STDs if you feel you may be at risk.
If I use the ring or an IUD and get a yeast infection, will I need to use a backup method of birth control while I'm on medication?
Luckily, intravaginal medications—like ones you would take for a yeast infection—will not interact with the ring or IUD, says Cullins. If you're using a vaginal ring like NuvaRing, you should not take it out while using the medication and you don't need to worry about decreased effectiveness, says Cullins. In clinical trials, hormone levels from the ring were not decreased by intravaginal medications. However, NuvaRing does have an advisory that suggests talking to your doctor if you need long-term treatment for a yeast infection, since regularly using oil-based, intravaginal medications may increase the level of hormones released into the blood. You can rest easy if you're an IUD user—since the device sits in your uterus, you don't need to worry about medications affecting it either.
If I skip a pill accidentally, what should I do?
It all depends on what kind of oral contraception you're on and how much time has passed. If you take a combination estrogen-progestin pill (the most common type of birth control pill) and less than 24 hours has gone by, just pop the next pill as soon as you realize your blunder, and you should be covered, says Dr. Streicher.
If it's been more than 24 hours, take two at the same time and use a backup birth control method like condoms for a week, just to play it safe. The one exception: If it's the first pill in your pill pack that you miss. "Since you've been without hormones for a week while you had your period, you're at a higher risk of pregnancy even after missing one dose," says Dr. Streicher. Whether it's been 12 hours or a full 24, take the next one ASAP and go on a backup method for seven days.
Women on progestin-only pills—nicknamed the "mini-pill" and prescribed to women who cannot take estrogen or are breastfeeding—are in a more precarious situation. They only have about a three-hour window to remember to pop their missed pill before risking a birth control failure. If three hours has passed, take the skipped pill ASAP, then the next one within 24 hours, and use a backup method for 48 hours. We know it can be confusing, especially when you're sweating over the possibility of an unplanned pregnancy. So if you're not sure what to do, double-check the insert that comes with your pill pack or call your ob-gyn.
Do I need to take the pills from my inactive week or can I just toss them out?
In terms of pregnancy prevention, the last few pills in your pack aren't necessary. "They're mainly there to keep you in the habit of taking the Pill at the same time every day," says Dweck. However, some newer birth control pills have added estrogen, iron, or folate to these for an added health benefit, so check with your doctor if you're not sure what your pill contains. The bottom line: Skipping the placebo pills won't decrease the effectiveness of your pill, but taking them may help you remember to start your next pack.
How important is it to take the pill at the same time every day?
You've heard it a million times—always take your pill at the same time each day. But in terms of preventing pregnancy, it's not a crucial step. The only exception: if you're taking the mini pill, a progestin-only birth control pill which must be taken at the same time every day, says Cullins. However, most women take the regular birth control pill, which contains a combination of estrogen and progestin. And on the Pill, you can miss a day and catch up while still being protected, so a few hours won't change the effectiveness. "On the weekend if you take your pill at noon instead of at 6AM, you don't need to be scared," says Cullins. That said, if you tend to forget to take your pill without setting an alarm, you might want to stick to a stricter routine. Plus, if you're on a very low-dose form of the Pill, you may experience some breakthrough bleeding if you're more than a few hours late, says Dweck.
Will my guy be able to feel my IUD?
He won't be able to feel the IUD itself, since it's implanted in the uterus, but some patients have complained that their man feels a slight poke from the string used to remove the device. "Sometimes the string is a little too long and passes from the cervix into the vagina," says Serina Floyd MD, MPH, an assistant professor of obstetrics and gynecology at Duke University. To fix this, Floyd suggests asking your gynecologist to trim the string a bit so it stays in your cervix. But keep this in mind: a shorter string may make it harder for your doctor to see if it's placed properly during your annual exam and it can make the removal procedure much more difficult, says Floyd. For that reason, it's best to leave it alone unless it's really bothering you or your partner.
I've heard that the birth control ring can pop out. What should I do if this happens?
First off, don't panic. You have a three-hour window to wash the ring and pop it back in before you need to use backup birth control like condoms, says Floyd. If it's been more than three hours and you're in the first two weeks of your cycle, wash it and put it back in, then use backup birth control for the next 7 days. If you're in the third week of using the ring and it has been out for more than 3 hours, toss it. You can insert a new ring immediately, but since this starts a new cycle, you'll likely miss your period or have some breakthrough bleeding. Another option is to leave it out and wait for your period to come, then put in a new ring no more than a week after the last one came out—but only use this option if the ring stayed in continuously the last 7 days before it popped out. Whichever option you choose, make sure to use backup birth control like condoms until the ring has been in for a full 7 days.
Additionally, if you've had unprotected sex after the three-hour period and didn't realize your birth control was missing, you may want to use emergency contraception as a backup, says Floyd.
Birth control and your cycle
Is there any day of my cycle when I'm least likely to get pregnant?
Unfortunately, there are no real "free days" in your cycle. That said, it's pretty unlikely to get pregnant while on your period, says Dweck. That's because you're most fertile when you're ovulating, which is typically around day 14 of your cycle (your cycle starts on the first day of your period). But here's where it gets complicated: you can become pregnant up to five days before and one day after you ovulate, says Cullins. Add to that the fact that sperm can live inside the vagina for five days! So while your period is generally the safest point in your cycle, experts still recommend sticking to a long-term birth control method if you're serious about preventing pregnancy.
Is there anything wrong with starting a new birth control pill pack if I want to skip my period week?
Not at all—women on the pill have been doing this for decades, and it's a completely safe way to postpone your period until you feel like getting it again, whether it's a week later or months later.
"The period you get when you're on oral contraceptives isn't even a real menstrual period but what's called a 'withdrawal bleed,'" says Dr. Streicher. There's no medical reason to have it, since the uterine lining doesn't build up because the pill prevents ovulation. But birth control pill manufacturers made it part of most pill regimens, as it made users feel more comfortable by mimicking their natural cycle.
If you want to put your flow on an indefinite pause, consider switching to a brand of birth control pill designed for this purpose. One type, called Seasonale, only results in four periods a year. And Lybrel, a second brand, is designed to be taken continuously so you never bleed unless you stop taking it, says Dr. Streicher.
Birth control and your health
I'm on a new birth control method but the side effects are driving me crazy. How long should I stay on it to see if they go away?
Nausea, headaches, breast tenderness, breakthrough bleeding—we feel your pain; going on a hormonal birth control method can trigger a whole cascade of these and other side effects. "The good news is, they typically ease up and then disappear within three months," explains Lauren F. Streicher, MD, assistant professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University. Try to hold out until the 90-day mark, and if they don't go away, see your gyno about trying a different method that might agree with your body better, suggests Streicher.
There is an exception to the three-month rule: If the side effects plaguing you include leg or chest pain or breathing difficulties. These can be tip-offs that a life-threatening blood clot has developed, so you should discontinue the BC and alert your doctor ASAP. Plus, any immediate side effects resulting in pain—say your guy's condom starts burning or stinging in the middle of sex, or the birth control ring hurts when it's inside you—remove the device and clue in your MD. Chances are it's just the result of irritation, allergy, or incorrect placement.
Are there any birth control methods linked to infertility?
No, and no matter how many times ob-gyns try to squash this rumor, it manages to persist. What's fueling it? It may have to do with a type of IUD that hit the market in the early 1970s that was linked to infections and fertility issues, says Dr. Streicher. But this IUD was pulled from the market instantly, and all three IUD versions available these days are safe and do not effect your baby-making ability in any way, says Dr. Streicher.
One caveat though: Before getting an IUD, make sure your doctor tests you for Chlamydia and gonorrhea. IUDs can increase your chances of developing Pelvic Inflammatory Disease—a fertility-threatening infection of the upper reproductive tract—if you already have one of these often symptom-less STDs at the time it's inserted, says Dr. Streicher.
If you only want to delay pregnancy for a few months, steer clear of the birth control shot, Depo-Provera: It can take up to 10 months for fertility to bounce back once you stop the shot, but it will return. The reality is, the day after you quit taking most birth control types, you can ovulate and conceive," says Dr. Streicher.
Is it actually harmful to use emergency contraception as my primary form of birth control?
No evidence suggests that it is. A 2010 review of emergency contraception by the Office of Population Research at Princeton University notes that no deaths or serious complications have been causally linked to the use of emergency contraception. Though the manufacturing information for Ella, the prescription-only form of EC—notes that you should not take Ella more than once in the same menstrual cycle.
That said, it's pretty dumb to rely on EC for pregnancy prevention. For one thing, at about $50 per dose in your local pharmacy, and you may experience side effects such as nausea, vomiting, and irregular periods within a day or two of use. And since you need to take most emergency contraceptive pills within 72 hours of unprotected sex for it to be the most effective, it's not the most reliable form of birth control. "Save money and time and give yourself peace of mind by talking to your ob-gyn about going on a real birth-control method that's more effective and works with your lifestyle," says Dr. Streicher.
Why does taking some forms of birth control help with conditions such as PCOS and endometriosis?
Another awesome benefit of hormonal contraception: It can ease symptoms of these fertility-threatening conditions, both of which an estimated 10 percent of women suffer from. PCOS stands for polycystic ovarian syndrome; it's triggered by a hormone imbalance that throws off ovulation and causes your periods to become erratic or MIA. "The artificial hormones in the pill, patch, ring, or hormonal IUD override this imbalance," says Dr. Streicher.
Endometriosis is different: it's a condition where uterine tissue migrates out of the uterus and attaches itself to other organs in the pelvic cavity, where it grows and thickens during your cycle before breaking down, just like tissue inside the uterus does. The main symptom is cyclical pain, like the kind you experience during your period, but it can also be constant and pretty intense. Taking hormonal birth control halts ovulation, and that can slows the migration of tissue out of the uterus and reduce the accompanying pain, says Dr. Streicher. If you have either condition or suspect you might, see your ob-gyn for tests and then an Rx.
How long should I be on hormonal birth control? Is there a reason to ever take a break?
There's only one reason to take a break from any form of birth control: if you're hoping to join the motherhood club. Otherwise, it's fine to stay on the Pill, patch, ring, implant, or other methods for as many years as you want, says Mary Jane Minkin, clinical professor of ob-gyn at Yale University School of Medicine. The one exception: Depo-Provera, the birth control shot. This progestin-only method is just as reliable as other hormonal birth control types, but because it's been linked to a greater potential for bone mineral loss, the FDA advises that most women only take it continuously for two years. It's something to discuss with your doctor, who will determine if you're at risk, says Dr. Minkin.
Overall, going on hormonal birth control for long stretches has some incredible body benefits, including a reduced likelihood of endometrial cancer and way-less-wicked PMS symptoms. Taking the Pill and using the ring also sinks your odds of ovarian cancer (the jury is still out on other methods, which haven't been studied as widely.)
On the other hand, a 1996 analysis of over 50 studies found that taking birth control was associated with a slight increased risk of breast cancer, though this risk disappeared after the women had been off the Pill for 10 years or more. More research is needed, but it's worth talking to your gyno if you have concerns.
The whole idea of needing a birth-control break stems from misinformation about artificial hormones—for example, that they accumulate in your body and cause disease, or that when you decide to go off them to have a baby, it takes time for the hormones to leave your body before your fertility kicks in again. (Depo-Provera is the odd man out again: It can take up to 10 months for fertility to bounce back once you stop the shot, but it will return.).
I've heard that being on birth control can increase your risk of developing a blood clot. How will I know if I have one?
It's true that being on hormonal birth control may put you at a slight increased risk of developing a blood clot. "However, the risk of getting a blood clot when you're pregnant is way higher than getting a blood clot while on birth control," says Dweck.
However, it's still crucial to keep an eye out for these suspicious symptoms: A clot in your leg will typically come with pain, swelling, redness, warmth, or tightness in one calf, says Dweck. A pulmonary embolism on the other hand is a clot that travels to your lungs and is typically accompanied by shortness of breath, heart palpitations, or chest pains. If you're experiencing any of these symptoms, call your doctor ASAP.
I've heard some foods and medications can interact with birth control. What are they?
It's true—some medications can interfere with your pill, including the antibiotic Rifampin (used to treat bacterial infections), St. John's wort, and some seizure medications, says Abbey Hardy-Fairbanks MD, an obstetrics and gynecology specialist at the University of Iowa Hospitals and Clinics.
But despite what you may have heard, the risk of antibiotics interfering with the effectiveness of your birth control pill is slim (with the exception of Rifampin), according to a 2011 Harvard study, published in the journal Contraception. Researchers found that women who took the pill while on antibiotics were no more likely to get pregnant than those who were not on antibiotics. Unfortunately, the study didn't completely rule out the possibility that they could cause a birth control failure, so until more research is done, it's a good idea to use backup birth control just in case.
As for foods that interact with birth control, a 2013 review published in the Canadian Medical Association Journal found that eating grapefruit or drinking grapefruit juice could increase the amount of hormones from your birth control pills that are absorbed into your bloodstream. Researchers found that ethinyl estradiol—a synthetic estrogen found in pills such as Yaz, Ortho Evra, Ocella, and Vestura—is affected by a natural chemical in grapefruit called furanocoumarin. It inhibits your gut enzymes responsible for deactivating drugs, so more of the chemicals may be absorbed into your system. The good news: Grapefruit won't make your birth control less effective. But you should be wary of this interaction if you have a pre-existing medical condition that makes you more susceptible to the side effects of birth control like high blood pressure or circulatory problems, according to the study's author David Bailey. If you're worried about a possible interaction, talk to your doctor or pharmacist about your risk.
Will I gain weight from birth control?
It could depend on your prescription. In 2011, researchers at the Cochran Database System Review analyzed 49 studies that compared a variety of birth control methods with placebos and found no evidence that hormonal birth control causes weight gain.
That said, a 2009 study in the American Journal of Obstetrics and Gynecology found that women using the Depo-Provera shot gained an average of 11 pounds and increased their body fat by 3.4% over three years, though the researchers aren't sure what may have caused this effect. If you're concerned about gaining weight, consider using a non-hormonal method of birth control or talk to your doc about your best options.
Will I lose my sex drive from birth control?
It's possible. Without birth control, your levels of estrogen and testosterone soar mid-cycle to boost your libido just in time for ovulation, says Dweck. You may also notice an increase in desire right before your period, as progesterone levels come down. But taking hormonal contraceptives halts ovulation, which levels out your hormones over the course of the month. In addition to that, birth control lowers a particular protein in the blood, which decreases the amount of lust-producing testosterone in your system, says Dweck. Essentially, hormonal birth control dampens these surges of desire that you naturally get throughout your cycle. However, in a 2012 review published in the Journal of Sexual Medicine, researchers analyzed 78 studies about how hormonal birth control affects your sex drive and found mixed results. A small percentage of women on hormonal contraceptives including the Pill, Depo-Provera shot, Implanon implant, and Mirena IUD had a decrease in libido. At the same time, a small percentage of women had an increased desire, while a majority of women studied were not affected at all.
If you think your birth control is curbing your desire, a non-hormonal method like the copper IUD or a barrier method like condoms may be your best bet. Even hormonal IUDs like Mirena may be helpful, since scientists aren't sure if this method actually halts ovulation, says Dweck.
Birth control laws
What kinds of birth control are covered with no co-pay under the Affordable Care Act?
Women's Health recently spoke with Mayra E. Alvarez, Director of Public Health Policy at the Office of Health Reform in the U.S. Department of Health and Human Services. Here is what she had to say about the options covered by the ACA: "The ACA actually covers all FDA-approved contraceptive methods. What we want to try to do in practice is ensure women have access to the services that are right for her, so this includes barrier methods, hormonal methods, and implanted devices. (Check the full list of FDA-approved methods.) The one clarifying thing you should know about: insurers are able to use reasonable medical management techniques to control their costs. So they may cover a generic drug without cost-sharing (so you wouldn't pay anything for this), but then charge if the woman chooses to go for a brand-name drug. The only instance where that's not the case is when a doctor prescribes a particular brand-name method based on the woman's needs."
I tried to get emergency contraception and the pharmacy wouldn't give it to me. Is this illegal? What do I do?
Whether or not it's illegal depends on your state. Arizona, South Dakota, and Idaho are among six states that can flat-out refuse to fill your script for moral or religious reasons. Eight states including California, Illinois, and New Jersey require pharmacists or pharmacies to provide patients with any medication they're prescribed. Seven states such as New York, Texas, and Oregon allow refusals, but pharmacists must find someone else to fill it for you. (Learn about your state laws).
Before heading to the pharmacy, call to make sure a pharmacist will be available—and willing—to help you when you arrive. If you're still turned down, go immediately to another pharmacy or Planned Parenthood to get it, says Sharon Levin, director for federal and reproductive policies at the National Women's Law Center. Emergency contraception is most effective the sooner you take it after unprotected sex, so it's important to get it as soon as possible.
If you live in a state that prohibits prescription refusals, contact the pharmacy's manager after the incident and report the problem, says Levin. "If the manager does nothing, contact your local women's rights organization and find out who to report the incident to," she says. However, if you live in a state that permits refusals or doesn't have a law either way, Levin suggests contacting law makers, filing a complaint with your state pharmacy board, telling your story to the press, or if it's a chain pharmacy, check to see what the company's policies are.
