Contraception and Safer Sex

Birth Control Pills
Depo Provera
Emergency Contraception Pill
Female Condom (Reality Condom)
Fertility Awareness Methods
Hormonal Contraceptive Patch (Evra Patch)
Hormonal Contraceptive Ring (Nuva Ring)
Intrauterine Device (IUD)
Intrauterine System (IUS)
Male Condom
Tubal Ligation

Birth Control Pills

What are oral contraceptives?

Oral contraceptives are taken orally by women on a daily basis to prevent pregnancy. Oral contraceptives contain either two hormones: progestin and estrogen (combined oral contraceptives) or only one hormone (progestin-only pills). Both are highly effective in preventing pregnancy if they are taken at the same time every day within a one hour window. Progestin-only pills can be used safely by women who are breastfeeding. Oral contraceptives are sometimes taken for other reasons to, such as regulating a woman’s menstrual period or treating acne.

Oral contraceptives come in either 21 day pill packs or 28 day pill packs. The former, contains 21 pills with hormones in them. The 28 day pill packs also contain 21 pills that have hormones in them and the remaining 7 pills are sugar pills designed to help you remember to take your pill every day.

How do oral contraceptives work?
Similar to other hormonal methods of contraception (e.g. patch, injection, ring), oral contraceptives work in 3 ways:
• They stop your ovaries from releasing an egg each month (ovulation)
• They change the lining of your uterus, making it thinner and more difficult for a fertilized egg to implant
• It changes the composition of your cervical mucous, which makes it harder for the sperm to enter the uterus.

How effective are oral contraceptives?
Typical use: Approximately 92% effective in preventing pregnancy
Perfect use: Approximately 99% effective in preventing pregnancy
* Oral contraceptives do not protect against sexually transmitted infections *
How do you I use oral contraceptives?
*Read the instructions that come along with your pill pack

For a 21 day pill pack…..
• Take 1 pill every day at the same time within a 1 hour window for 21 days. For example, if you normally take the pill at 8:00 am, make sure you take it daily between 7:00am and 9:00 am. If you do not take the pill within a 1 hour window every day its effectiveness will decrease.
• After 21 days, do not start a new pack of pills for the next 7 days. During these 7 days you will have your period.
• After 7 days open up a new 21 day pill pack and start a new pill cycle.

For a 28 day pill pack…..
• Take 1 pill every day at the same time within a 1 hour window for 21 days.
• After 21 days, you can either avoid taking pills for the next 7 days or you can take 1 sugar pill a day. You can also take a sugar pill out and discard it instead of swallowing it. These sugar pills are usually coloured differently from the other pills in the pack and are only designed to help you remember to take your pill on time everyday.
• After 7 days open up a new 28 day pill pack and start a new cycle.

*During the first month of taking the pill, it is recommended that you use a backup method of contraception such as condoms and spermicide. Your body takes a bit of time to adjust to the hormones and it also takes some time for the hormones to take effect. During the first month, you are also getting used to a new routine.

Continuous use of oral contraceptives…..
Some women use oral contraceptives continuously, without taking a break to menstruate. If you are interested in using hormonal contraceptives continuously, make sure to check first with your family doctor, obstetrician/gynaecologist or sexual health centre to ensure that you are able to do so with your brand of pills and that it is safe for you to do so.

Much of the research that has been done so far indicates that using hormonal contraceptives continuously for short periods of time is safe. There is also a specific version of the pill (Seasonale) that is specifically designed for continuous use. This pill is taken once a day for 91 days followed by 1 pill free week. Women who use this pill will experience 4 menstrual periods per year. This version of the pill contains both oestrogen and progestin.

The following are some reasons why women choose to use hormonal contraceptives continuously:
• It allows for greater control over menstrual periods
• If a woman is going away on a vacation or holiday or is attending a special event she can delay having her period until the vacation/event is over
• It can be helpful for women who normally experience a lot of bleeding and cramping during their periods.
• Some women do not want to have their menstrual periods.

*For some women, going long periods of time without menstruating is an advantage, whereas for other women it may feel unnatural. The choice is yours to make. Whichever way you choose to use the pill, it can be helpful to get information on both the advantages and the disadvantages so that you can make an informed decision.

What if I miss a Pill?
If you miss 1 pill at any time throughout your cycle…..
• As soon as you remember, take the missed pill and take your next pill at the usual scheduled time.
• For the next 7 days use a backup method of contraception such as condoms and spermicide

If you miss 2 pills during the first 2 weeks of your cycle…..
• Double up and take 2 pills for the next 2 days and then continue take 1 pill a day at the same time for the rest of the cycle.
• For the next 7 days use a backup method of contraception such as condoms and spermicide

If you miss 2 pills during the third week of your cycle…..
• Throw the current pack of pills out and start a new cycle of pills as soon as you remember
• Use a backup method of contraception such as condoms and spermicide for the next 7 days.
• You may not experience a period this month because you are taking the pill continuously for longer than usual.

If you miss 3 or more pills at any time during your cycle…..
• Consult with your doctor or the Sexual Health Centre as soon as possible. You may need emergency contraception. If you cannot consult with a doctor right away you can purchase emergency contraceptive pills over the counter at pharmacies without a prescription. If you have purchased emergency contraception ahead of time and already have it readily available you may want to consider taking it.
• You may not experience a period this month.

What can be the advantages of using oral contraceptives?
• Highly effective in preventing pregnancy
• Allows a woman to take control over her fertility
• It is fairly discrete and no one needs to know you are using them
• Can help control acne and improve the condition of your skin
• Can help regulate your period
• Can reduce cramping and bleeding during your period
• There are many different brands and variations of the pill that you can try. If you experience side effects from one type of pill you can always switch to another kind.

What can be the disadvantages of using oral contraceptives?
• You need a prescription
• You need to remember to take the pill at the same time every day within a one hour window or the effectiveness will decline. For some women it is easy to remember but for others it can be more difficult.
• You may experience side effects such as: headache, breast tenderness and breakthrough bleeding (bleeding between periods). Most side effects go away after a couple of months but if they persist, you can try switching to another pill or a different method of contraception entirely.
• In rare cases the pill can lead to certain complications. If at any time you experience shortness of breath, severe abdominal pain, dizziness or any other unusual symptom, stop taking the pill right away and seek immediate medical attention.
• Some women are sensitive to hormones and can experience mood swings while on the pill.
• Does not protect against sexually transmitted infections (STI)

Where can I get oral contraceptives?
Oral contraceptives are available at pharmacies with a doctor’s prescription. If you are under 25, you can also get them at the Sexual Health Centre (179 Clarence Street in Ottawa) for a reduced price.

How much do oral contraceptives cost?
Pharmacy: Approximately $30/month but can be more or less depending on the individual pharmacy’s dispensing fee.

Sexual Health Centre:
• Under 25: $10 per pack (month)