Last updated: Aug 07, 2008
hilda-hutcherson
"There's no such thing as 'too young for birth control.'"
(DOMENICA COMFORT)

Hilda Hutcherson, MD, is a clinical professor of obstetrics and gynecology at Columbia University Medical Center in New York City and author of What Your Mother Never Told You About Sex.



Q: If I have sex without a condom and I'm not on birth control, what's the chance I'll get pregnant?

A: There's about a 20% chance that you'll get pregnant during any given monthly cycle. While that doesn't sound very likely, the percentage goes up if you continue to have sex without a condom.


Q: What can I do to prevent pregnancy if the condom broke during sex and I'm not on birth control?

A: You can take the morning-after pill, also called Plan B, up to five days after an accident like that, but it's most effective if you take it within 72 hours. You can get it over-the-counter at any pharmacy if you're 18 or older. It's essentially a high dose of progesterone. Although we don't know exactly how it works, it's believed to prevent ovulation.


Q: Is it true that there's a birth control pill being developed for men?

A: They've been working on that for many years, but so far there's nothing on the market.


Q: Is hormone-based birth control such as the Pill safer than it used to be?

A: Yes, the dosing is lower and more precise in the newer formulations. But hormone-based birth control carries some risk for blood clots, heart attack, and stroke, and smoking increases that risk.


Q: Is it safe to take those birth control pills that reduce your periods to just four times a year?

A: Having so few periods doesn't seem to cause any problems as far as we know. There haven't been any long-term studies, however, to see whether these pills are any riskier than regular birth control for blood clots, heart attacks, or stroke.

 

 

 

 

 

 

 

 

 

Q: Other than its ability to prevent pregnancy, are there benefits of going on the Pill?

A: Yes, studies have shown that women on the Pill have a lower risk of developing ovarian and endometrial cancers—even years after they stop their daily doses. The Pill can also help women who have problems with heavy bleeding, PMS, severe menstrual cramps, or endometriosis. And some formulations can reduce acne breakouts.


Q: Which form of birth control is the most effective?

A: Birth control pills are probably the best—especially for young women. Theyre easy to take, and if taken properly, their effectiveness is high. They also have few side effects. I don't think many doctors are prescribing patches these days because they have a higher risk of blood clots and some people have died while using them. Progestin shots are as effective as the Pill, but they have more side effects, such as weight gain, moodiness, water retention, depression, and spotting. Intrauterine devices (IUDs) are very safe and effective, especially for women who have carried a child, as they're less likely to experience side effects such as cramping.


Q: Why is it so important to take the Pill on time, every time? What should I do if I miss a dose?

A: If you take it at different times, say one day at noon and the next day at 4 in the afternoon, your body will notice the drop in the hormones and think it's time to bleed or ovulate. If you miss a dose, however, you can double up the next day and you should be OK if you've been taking them regularly. But just to be safe, also use a condom for the rest of that cycle.



Q: If I don't want to have any more children—or any children at all—what are my options?

A: If you are over 35 and sure you don't want children, you may want to be sterilized. You can do it with laparoscopic surgery that burns and cuts the fallopian tubes; you can have your fallopian tubes cut after childbirth; or an implant can be inserted without surgery into your fallopian tubes to cause scar tissue that blocks them. You could also ask your partner to get a vasectomy.

If you're under 35, I don't usually recommend sterilization. I've seen too many women change their minds when their life situations change. And it's not easy to reverse sterilization. For women under 35, I might recommend using an IUD. It's safe, effective, nonpermanent, and can stay in for up to 10 years. If a woman does eventually decide to have a child, she could just remove the IUD.

Q: Is sterilization reversible?

A: It depends. If you have your tubes tied after childbirth, it's easier to reverse than the laparoscopic procedure where your fallopian tubes are burned. Today many doctors don't bother reversing the tubal ligation and go straight to in vitro fertilization (IVF). Even if you've been sterilized, pregnancy is still possible with IVF.


Q: Is there a certain age when a girl should start taking birth control? How young is too young?

A: There's no such thing as "too young for birth control." If a girl is capable of getting pregnant and she is having sex, she is old enough for birth control. Preventing a girl from using birth control won't stop her from having sex.


Q: Which forms of birth control protect against sexually transmitted diseases?

A: Only condoms do that. Diaphragms can prevent gonorrhea and chlamydia infections but they won't protect against other diseases such as HPV, HIV, or herpes.


Q: Why do some birth control pills clear up your skin while others make you break out?

A: It's the progestin. Some have more androgen-like properties that cause acne, and others do not. The ones without these male-hormone-like properties can actually be used to treat acne.


 
 

Q: Are IUDs still dangerous?

A: IUDs had a bad rap many years ago when they caused severe infections and infertility, but the newer IUDs work quite well and are very safe. I recommend them to people who have had at least one child and are in monogamous relationships. If a woman hasn't had a child and tries an IUD, she is more likely to experience pain, cramping, and bleeding because the uterus hasn't expanded before and the body tries to kick it out. And if she's not in a monogamous relationship, having multiple partners increases the risk of gonorrhea and chlamydia, which can lead to infections of the pelvis and cause infertility. Having an IUD can make those infections worse.


Q: What is a female condom?

A: The female condom is a great method of birth control—especially if your partner complains that male condoms are uncomfortable. It's a polyurethane condom that is inserted into the vagina, with part of it covering the vulva. It can protect you against bacterial and viral infections, so you have a reduced risk of catching herpes or HPV than when using a regular condom. The only problem with the female condom is that it is different from what people are used to. It's bulky and can make some noise during use.


Q: What can I do if I lose my sex drive while on birth control pills?

A: You can switch to a different pill. Not all pills affect all women the same way. I usually recommend switching to a pill with lower estrogen levels or a different kind of progestin. Or you might decide not to take the Pill at all and use a barrier method, such as a condom or diaphragm.


Q: Can I get pregnant if my boyfriend pulls out before he climaxes?

A: Yes! That is not a dependable method of birth control. Your boyfriend can always release sperm in the pre-ejaculate or pre-cum, so you shouldn't depend on that as your sole form of birth control if you want to avoid pregnancy and sexually transmitted diseases.