Contraceptive Options

This is a brief guide to all the different methods of contraception available. You need to choose a method that you find easy and convenient so that you can relax and enjoy sex without worry.

Different methods might suit you better at different stages of your life. For more detailed information, talk to your doctor, health clinic (your CLSC in Quebec) or your pharmacist.

Barrier methods and spermicides

There are a number of different barrier methods of contraception to choose from. This section describes them all. To be extra careful, you should always use spermicide too.

• Male condom

  This is a thin latex or polyurethane sleeve that fits over the man's penis. It's closed at one end with a point at the top to hold the sperm when he ejaculates. The condom is rolled down over the penis and prevents sperm from entering the woman's vagina. As soon as he has ejaculated, the man should hold the condom on his penis to prevent any sperm escaping as he withdraws.

  Although they're very strong, condoms can occasionally break. (If this has happened to you within the last 72 hours, and you're worried that you might get pregnant, you can always use plan B.)

  Condoms help to protect both partners from STDs and STIs, including HIV/AIDS, but they're not as reliable at preventing pregnancy as other methods. Lots of couples use a condom to protect against infections and use another more reliable form of contraception, like the pill, to prevent pregnancy.

• The diaphragm and the cap

  A diaphragm/cap is a dome shaped circle made of rubber or silicone that you put inside your vagina to form a barrier between the man's sperm and the entrance to your cervix (womb). You can insert it up to 3 hours before you have sex and should use spermicide as well.

  Before you use a diaphragm, you have to go for a fitting to make sure you get the right size. It should be checked every 6 months to make sure that it still fits snugly. When it's inserted properly, it doesn't interfere with sex and the man is not aware of it. After sex, you have to leave it in for at least 6 hours so that the spermicide has time to work.

• Female condom

  This is a stretchy sleeve made from lubricated polyurethane. It's closed at one end and designed to line the woman's vagina to prevent sperm entering the cervix (womb). It looks a bit like the male condom, but is wider and has flexible rings at either end to hold it in place. One ring goes inside, and the other outside. It can be inserted any time before sex and removed any time after the man has ejaculated and withdrawn.

  Female condoms help to protect both partners from STDs and STIs, including HIV/AIDS, but are not as reliable at preventing pregnancy as other contraceptive methods. Lots of couples use condoms for protection against infection and use a more reliable form of contraception, like the pill, to prevent pregnancy.

• Spermicides

  Spermicides are not a method of contraception, but rather, increase the effectiveness of barrier methods. They work by killing sperm or reducing their mobility so they can't get into the womb. You can buy spermicides as a foam, gel, cream, or a film. Some barrier methods of contraception already come with spermicide.

  Using a spermicide alone will not stop you from getting pregnant and won't protect you from STDs or STIs, such as HIV/AIDS.

Oral contraception (the birth control pill)

The pill is one of the most reliable methods of contraception. You can get the pill (and all contraceptives) from your doctor or health clinic (your CLSC in Quebec).

The birth control pill contains 2 hormones - an estrogen and a progestogen, which prevent your body from releasing an egg each month. It makes your periods more regular, lighter, and reduces period pains and cramps.

Although the pill may not be suitable for a small minority of women with certain conditions, healthy non-smokers can take it right up to menopause. Your doctor will take your full medical history before prescribing the pill.

Some women may have side effects when they first start taking the pill, but usually these subside after about 12 weeks. Side effects can include "spotting" between periods, headaches, and breast tenderness.

Rarely, a few women will suffer serious side effects, such as thrombosis, but this is very uncommon.

Some brands of the pill contain a higher dose of estrogen. If you're on this type of pill and are suffering from side effects, it might be helpful to ask your doctor if you can switch to a low-dose estrogen pill. No one pill suits everyone so it's worth discussing different options with your doctor.

Intrauterine contraception (IUD)

The IUD can be used as emergency contraception, as well as a long-term method of contraception.

The IUD is a small T-shaped frame with a thin copper coil around the stem, which is inserted into the neck of the womb and must be fitted by a trained health care professional. It is normally used as a method of long-term birth control but can also be used to prevent pregnancy in an emergency.

It has two little threads that lie inside the vagina so that you can check if it's in place by giving it a gentle tug.

With the IUD, your periods may become heavier, longer or more painful. Infection of the womb can occur with this method and if you have any reason to think you may have an infection, don't wait to get checked. Make an appointment with your doctor right away, or go to a walk-in clinic. Untreated infections can, in severe cases, mean that you may find it difficult to have children later in life.

Different types of IUDs have to be changed at different intervals of between 3 - 10 years. When you don't want to use this method any more, you need to make an appointment with your health care professional to have it removed.

Injectable contraception

This is a hormonal method of contraception, which is injected once every 2 or 3 months. The hormone, which is a progestogen, is released very slowly into the body and prevents release of an egg from the ovary and thickens mucus around the neck of the womb, making it difficult for sperm to enter.

The injections are given by your doctor or health clinic (your CLSC in Quebec). Once you've had the injection, you won't have to think about contraception for a while. Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. When you stop the injections, regular periods and fertility may take up to a year to return.

Implants

This is a tiny flexible tube impregnated with the hormone progestogen, and inserted just under the surface of the skin on the inside of your upper arm. Implants must be inserted by a trained doctor or nurse under a local anesthetic. The hormone is released in tiny doses over a 3 year period, after which, it's taken out and a new one is inserted.

This method thickens the mucus in the neck of the womb to make it difficult for sperm to enter. It also changes the lining of the womb so that it will not accept a fertilized egg. In some women, it will also prevent ovulation.

There can be temporary side effects such as headaches, mood changes, and breast tenderness, but usually these subside after the first few months. Some women may put on weight and some find that their periods become less regular after the first year.

Contraceptive patch

This is a small square adhesive patch, impregnated with the hormones estrogen and progestogen, which are slowly absorbed through the skin. You stick it onto your buttocks, stomach or upper body and change it once a week for 3 weeks. On week 4, you don't wear a patch.

If you apply your first patch on the first day of your period, it will work for the rest of that monthly cycle. If you apply your first patch at any other time of the month, you need to use additional contraception, such as a condom and spermicide for the first 7 days. If you miss your patch-change day by more than 2 days, you need to start a new 4-week patch cycle.

The patch works by preventing ovulation and thickening the mucus around the neck of the womb, making it difficult for sperm to enter.

Some women will have side effects when they first start wearing the patch, but usually these subside after about 12 weeks. They can include "spotting" between periods, headaches, and breast tenderness.

Natural methods

These methods involve using some means of finding out when you're at your most fertile, so that you can be extra careful or avoid sex altogether at these times.

There are a number of things you can do, and using a combination of them all is best. You should:

• Keep a daily record of your body temperature using a special fertility thermometer
• Look for changes in the stickiness of the mucus around the entrance to the womb
• Calculate when ovulation is most likely to take place by counting the number of days from your last period (this only works if your periods are regular)
• Look for other signs such as mood changes and breast tenderness which tend to happen in the second half of your menstrual cycle (measured from the start of one period to the beginning of the next)

To use all the steps above in combination, you need to be highly motivated and well taught. Consult your doctor or health clinic (your CLSC in Quebec) first. Natural methods of contraception are less reliable than barrier or hormonal methods and there is a higher risk of pregnancy.

Personal contraceptive computer

This is a small, computerized, hand-held monitor that tests your urine for hormonal changes in the body and can be bought at the pharmacy. The system can help you figure out when your fertile and infertile times of the month are. This method needs commitment and motivation, and it can be expensive. If you don't want to get pregnant you have to avoid sex altogether or use an alternative method of contraception (such as condoms or a diaphragm/cap) during your fertile time.

Withdrawal method

This is one of the oldest methods of contraception and also one of the least reliable. When you are having sex, the man has to take his penis out of your vagina before he ejaculates. The idea is that this does not allow sperm to enter the woman's vagina.

This method requires a great deal of control from the man and frequently fails because small drops of sperm can escape from the penis into the vagina, before the man fully ejaculates.

Sterilization

Although in men it can be reversed, sterilization should always be thought of as an irreversible method of contraception. Both partners, therefore, have to decide they definitely do not want any more children. Anyone who opts for sterilization is always given or offered counselling first.

• Male sterilization (vasectomy)

  This involves a minor operation that takes 10 - 15 minutes and is carried out under a local anesthetic. The tubes that carry sperm are cut, so that while a man can still ejaculate, there's no sperm present. After the operation, it usually takes a few months for all the sperm to disappear from the semen, so another method of contraception has to be used in the meantime. After 2 negative sperm tests, taken approximately 4 weeks apart, it's considered effective. Having a vasectomy does not alter a man's sexual performance or enjoyment of sex.

• Female sterilization

  This is the only permanent method of contraception available to women and if this is something you're seriously considering, you should have counselling first.

  The operation can be done under a local or general anesthetic and involves cutting or blocking the Fallopian tubes so that the egg cannot travel down to meet sperm. Sterilization takes effect immediately after the operation and you may have to spend 1 to 3 days in the hospital. Periods continue as usual but some women may find their periods are heavier than before.

  This is the most permanent method of birth control and should not be considered if you're in any doubt about whether you may want to have children, or more children later.

Emergency contraception

Emergency contraception is a method of preventing pregnancy after unprotected sex. It's simple, safe, and effective, and is intended as a last resort to prevent pregnancy for those who don't want to become pregnant right now. Emergency contraception, however, is not meant to be used as ongoing contraception. You can find all the emergency contraception information you need on this website.