Hormonal birth control: widely used, widely misunderstood

I thought I would address hormonal birth control first, since it is so widely used. It is not only used for the prevention of pregnancy, but is also frequently prescribed by physicians for the treatment of painful menses, regulation of cycle length, and perimenopausal physiological issues.

The most common reason for discontinuing the use of hormonal birth control is the uncomfortable side effects. These can include, but are not limited to: nausea, vomiting, bloating, constipation, breast swelling/tenderness, weight gain, mood swings, depression, vaginal infections, high blood pressure, bone density loss, and enlarged ovarian follicles. In many cases, the decrease in libido alone is enough to contribute to the effectiveness rate of hormones!

When my husband and I got engaged, I ran straight to the doctor to get a prescription for birth control. We didn't want to have to mess with condoms or other barrier methods, and we wanted a very effective form of birth control, as we planned to wait at least a year after our marriage before attempting to conceive. One of the side effects that I dealt with early in our marriage was painful intercourse. There was about one week a month where sex was completely pain-free, and one week where it was excruciatingly painful, and the other two weeks had some level of pain in between these two extremes. But more about my personal story later.

(Quick note: when referring to birth control methods, "typical use" refers to the fact that most women do not use birth control correctly 100% of the time. It refers to the likelihood that the average woman using the method will avoid pregnancy. "Perfect use" assumes that the user will use the method absolutely correctly every single time.)

"The pill" is the most commonly used hormonal method of family planning. A pack of pills usually contains 21 active pills followed by 7 "sugar pills" (placebos). The week when the placebo pills are taken is when the "menses" occurs. I put that in quotation marks because it is not really menses at all, but withdrawal bleeding from lack of hormones. There are other combinations of pill packages, including Yaz 28 and Loestrin 24 Fe that include 24 active pills and 4 inactives. Also newly on the market are Seasonale (77 active pills, 7 inactive), Seasonique (77 active pills, 7 low-dose ethinyl estradiol pills), and Lybrel (365 active pills, with no inactive pills). Perfect use: 99.7% effective. Typical use: 92% effective.

The birth control patch is another method. (OrthoEvra is the most common.) It is a 4 inch square patch that is applied to the stomach, buttocks, arm, shoulder, or torso. The patch is changed once a week for three weeks, and no patch is applied the final week of the month. Perfect use: 99.7% effective. Typical use: 92% effective.

The vaginal ring is an increasingly popular prescription, under the name NuvaRing. It is a clear ring that is held in place by the vaginal muscles. It is inserted for three weeks, then removed for a week, and a new one is inserted. (That would be the annoying commercial with the three girls sitting around the TV having the most unrealistic conversation in the world.) Perfect use: 99.7% effective. Typical use: 92% effective.

The mini-pill is becoming increasingly popular among breastfeeding women, since it only contains progestin, and no estrogen to be passed to the nursing child. They contain 28 pills which are all considered to be active. Perfect use: 99.7% effective. Typical use: 92% effective.

Finally, we have the birth control shot; the most commonly known is DepoProvera. It is an intramuscular injection which is received every 11-13 weeks. It has been in the news in recent times for causing loss of bone density when used long-term, and also should be discontinued about a year before pregnancy is desired, because the hormones can take up to 10 months to leave the body. (It should be duly noted that ANY form of hormonal birth control takes at least 3 months to fully leave the bloodstream, and thus should be discontinued about that length of time before trying to conceive.) Perfect use: 99.7% effective. Typical use: 97% effective.

Another personal note of disclosure: It took approximately 7 months for my cycles to straighten out after I ceased the use of hormonal birth control. Thankfully we weren't trying to get pregnant at the time, but it does cause many issues for many women. It can take months or even years for their fertility to return.)

Hormonal birth control prevents pregnancy by two means: first, it prevents ovulation so that no eggs are released, and thus pregnancy does not result. The second method (the "back-up" method, if you will) is to make the uterus an inhospitable environment for a fertilized egg to implant, in case of the first means failing. The main objection that many women have to hormonal family planning is just that: if life begins at conception, then they do not want to take the chance of preventing life from being able to implant and grow properly. (I do take this view: although I stopped the use of hormones due to undesirable side effects, I later learned of this second method of preventing pregnancy, which made me extremely uncomfortable. It was the side effects that made me stop its use, and the method of action that keeps me from returning to it.)

Hopefully this has provided some thought-provoking material, regardless of what readers choose to do with the information. I hope that regardless of the final decision of my readers, that they are well-informed and intentional about their family planning choices.