Six things your provider wishes you knew about birth control

No, it doesn't affect your fertility

In my practice, I have heard from a lot of people about their worries and concerns about birth control. There are some really common misconceptions out there about birth control, and I’m here to clear some of them up.

1. You don’t need an exam to get most types of birth control.

You’re sitting on the exam table in a paper gown, sticking to the table paper, waiting for some stranger to talk to you about your birth control, and thinking, “is this really necessary to get my prescription refilled?” Probably not—the good news is most birth control methods don’t require a physical exam. Unless you’re getting an IUD, you don’t need a pelvic exam or an STI test, and you never need to get a Pap smear to get birth control. While those things are generally recommended for most people, they just aren’t necessary before you can get your birth control.

Want to skip the in-person visit all together? You can even order the pill, the patch, and the ring online or with an app, so you don’t even have to leave the comfort of your couch to get your birth control delivered to you.

2. Using birth control now doesn’t affect your chances of getting pregnant in the future.

I hear this worry a lot, but the truth is that there is no birth control that changes your chances of getting pregnant in the future (other than permanent methods like having your tubes tied or a vasectomy).

If you use a method that has to be used every time you have sex to prevent pregnancy, like condoms, internal condoms, the diaphragm, or the withdrawal method, you can get pregnant anytime you have sex and don’t use your method.

If you are using the pill, the patch, the ring, the hormonal IUD, or the implant, you can get pregnant within a day to a few weeks after stopping your method. If you are using the shot, the hormones stay in your body for at least 13-15 weeks after your last shot, and it’s possible to get pregnant as soon as 1 day after the shot wears off. For some people the hormones in the shot can stick around for up to 9 months and decrease your chance of getting pregnant during that time.

If you are using the non-hormonal IUD, you can get pregnant as soon as it is removed, even the same day.

You may have heard someone say they couldn’t get pregnant after being on birth control, but difficulty getting pregnant is caused by things that most people don’t think about until they go off birth control and try to get pregnant. Things like how old you are, a history of PID (which can cause scarring that blocks the fallopian tubes and makes it harder for eggs and sperm to meet), PCOS, or endometriosis can all affect your chances of getting pregnant but being on birth control doesn’t change that. After you stop using any method of birth control, your chance of getting pregnant goes back to what is normal for you.

3. Birth control is a healthy choice.

All the FDA-approved birth control methods have gone through extensive research showing they are safe to use and effective at preventing pregnancy. Some even have other benefits, like making your periods shorter, giving you periods with less cramping, and improving acne. For some people, like those with PCOS, using birth control to regulate their periods now can actually increase their chances of getting pregnant in the future.

Even though birth control is safe, not every method is a good fit for everyone. Some people, like those with high blood pressure or a history of the type of blood clots that can cause a stroke, shouldn’t use methods that have estrogen, like the patch, the ring, or some types of the pill, since estrogen can increase the risk of having a blood clot. And some people just don’t want to use hormones at all. The good news is that there are hormonal methods without estrogen for people who need them, like the hormonal IUD, the shot, the implant, and the mini-pill. There are also methods without any hormones at all, like the non-hormonal IUD, condoms, and fertility awareness methods. You might have to try a few to find the right one for you, but there is a method out there to fit your life!

I’ve heard questions about other things, like some foods or supplements, that people think can be used as birth control, but none of them are effective at preventing pregnancy, and some of them can even be dangerous.

4. There may be an adjustment period.

Changes to your period, breast tenderness, nausea, and other side effects can happen when you start any new method. These changes don’t mean that there is something wrong. Methods that only have progestin, like the shot, the implant, the hormonal IUD, and the mini-pill are likely to change your periods. How much your bleeding will change is hard to predict. With progestin-only methods it would be normal (and safe), for you to have no bleeding, bleeding that comes and goes, or even bleeding every day. So, if it’s important to you to have a regular, predictable period, these methods might not be a good fit for you. Instead try the pill, the patch, the ring, or any non-hormonal method, like condoms, internal condoms, the non-hormonal IUD, or fertility awareness methods.

For other birth control with hormones, like the pill, the patch, and the ring, it would also be safe and normal to have changes to your period. While some people don’t notice a change to their periods, you could have bleeding between periods, lighter periods, or no periods at all. Some people even use these methods to safely skip their periods altogether.

Most of the time symptoms like nausea and irregular bleeding get better after a few months. Your provider might have some suggestions, like taking your pills in the evening to help with nausea or using other medications to help with irregular bleeding. At any time, if you are not happy with your method, it’s always okay to switch. Sometimes it takes trying a few methods to figure out which one works for you and your life.

5. You don’t need to take a break from birth control.

I get questions about whether you need to take a break from birth control a lot, especially from people who don’t have a regular period because of their birth control (see number 4) or are worried about their chances of getting pregnant in the future (see number 2). In fact, there is no medical need to take a break from birth control to “clean out your system” or for any other reason.

The truth is, the hormones in birth control are out of your system so quickly that if you don’t want to get pregnant immediately after you stop taking birth control, think about starting another method right away to stay protected from pregnancy. If you have sex while you are not using birth control, or if you have a whoops moment and don’t want to get pregnant, consider using emergency contraception to prevent pregnancy.

6. We aren’t here to judge.

I don’t care what method my patients use. I just want them to love their method and have it work for them. The best method for you today might be totally different than what is best for your sister, your friend, your provider, or even what was perfect for you last year (or last month). Thinking about what is most important to you in a method, like having regular periods, being able to keep it private, or having one that also protects you from STIs, can help you find a method. But it’s also okay (and very common) to try different methods until you find one that works for you and your life.

I think I can speak for most providers when I say that we’ve heard and seen it all. It doesn’t matter to me how many people you’ve had sex with, if you’ve missed a pill, had unprotected sex, or have a STI—I want to be there for my patients no matter what, to hear from them if they have questions or just want to talk. My job is to help my patients live their best life. Shame and guilt have no place in the exam room. If your provider isn’t showing you the respect you deserve, isn’t listening or hearing what you have to say, or is making you feel bad about your sex life, it might be time to find a new provider.

Written by Robin Watkins, CNM, WHNP-BC

Robin Watkins is the Senior Director, Health Care at Power to Decide. Robin is a midwife and women’s health nurse practitioner focused on helping other providers learn how to offer high-quality sexual and reproductive health care. Robin provides clinical care at a community health center in Washington, DC. When she is not talking sex, placing IUDs, or asking One Key Question, you can find her riding her bike on the streets of DC or eating ice cream for dinner.

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