7 Questions You Still Have About Birth Control, Answered

Question: “I often get confused about antibiotics, various medications, and birth control.”

Answer: A friend of mine got pregnant in high school and was sure that it was because the antibiotics she was taking messed up her birth control. But as an adult — and through my sex education training — I’ve learned that the vast majority of antibiotics don’t actually interfere with hormonal birth control. The one exception? A very intense antibiotic that’s used to treat lung infection tuberculosis, called rifampin or rifabutin. But considering tuberculosis is largely eradicated in the United States, probably most of us don’t have to worry about that.

There are, however, other meds that can interfere with the effectiveness of hormonal birth control. If you have bipolar disorder or epilepsy and are taking medication — especially Barbituates, Carbamazepine, Oxycarbazepine, Phenytoin, Primidone, Topiramate, Felbamate, and Lamotrigine — you may want to consider another form of birth control, as there is evidence that these meds can make hormonal birth control less effective. Some HIV medications (but not all) also reduce the effectiveness of hormonal birth control, as does the anti-fungal medication Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol). And on the naturopathic side of things, there’s some evidence that St. John’s Wort does as well.

Question: “Do IUDs make you spot more? Which birth control method is the best for not having as long/as heavy of a period?”

Answer: First, let’s talk about the two types of IUDs: copper and hormonal. The copper IUD — which is sold under the brand name ParaGuard — has no hormones, which many people really like, but it does come with side effects. Most notably, people using the copper IUD report heavier periods — and that can include painful cramping. Many people also report spotting between periods and it may cause irregular periods.

The hormonal IUD — which is sold under the brand names Mirena, Skyla, Kyleena, and Liletta — is a different story. It releases a very small amount of the hormone progestin into your body over a few years. Progestin is the synthetic form of progesterone, which is one of our reproductive hormones. While the copper IUD may cause heavier and more painful periods, people on the hormonal IUD usually report the opposite. Periods are often lighter and, in some cases, go away altogether. So if you’re looking for a good option for reducing the length and heaviness of your period, a hormonal IUD is probably your best bet.

Another option is to take a hormonal birth control pill and skip the “sugar pills” so that you don’t get a withdrawal bleed every month. (Some people call the bleeding that happens on the Pill their “period,” but it’s actually biologically different.) This is totally safe to do and lots of people who have difficult periods choose this option. Similarly, the patch can also be used to skip your “period” (that’s also a withdrawal bleed) and for one in three people, the implant also results in no more periods after one year.

Question: “How soon can you get pregnant once you stop using birth control?”

Answer: There’s this myth out there that it takes three months to return to fertility after stopping the Pill, Patch, or Nuvaring — but your body can return to fertility pretty much immediately after you stop taking hormonal birth control, although it can take a couple of months for some people to get back on a regular cycle.

Does that mean you’ll get pregnant right away? Not necessarily. That’s because there are many factors beyond fertility that contribute to someone’s ability to get pregnant or not. It may take up to a year or even longer, but that’s the same for any person, regardless of whether or not they’ve just gone off hormonal birth control.

But think about it: How many stories have you heard of women missing a pill or two and then getting pregnant accidentally? That’s probably the strongest anecdotal evidence of all!

Question: “Will it hurt getting the implant? Will I feel it all the time? How does the process work?”

Answer: The birth control implant — which is sold under the brand name Nexplanon — is a great, long acting reversal contraceptive (LARC). It’s inserted under the skin of your arm and releases a little bit of progestin every day for five years. But it totally makes sense that you’re wondering about pain during insertion! After all, it’s a little, matchstick-sized tube that goes under your skin.

So what’s implantation like? Your doctor will give you a numbing shot before inserting it, which means you shouldn’t actually feel the insertion itself. So while the shot might not feel the nicest, it won’t be any more painful than going to the dentist. (And will probably be less.) It might be a little sore after the numbing medication wears off, but nothing major.

As for whether or not you’ll be able to feel it all the time, that depends on how often you touch it! Because it’s inserted under the skin, you can definitely poke at it and show it off to people to freak them out, if you want. But other than that, you shouldn’t feel it.

Question: “When will a male birth control pill exist?”

Answer: GOOD QUESTION! Ugh, the lack of male contraceptives is something that truly drives me nuts. It’s mind boggling that women are put almost 100 percent in control of reproduction. Also, it’s not fair that men and other people with penises don’t have more options for controlling their own reproductive future! Big thumbs down.

So while we don’t have any male contraceptives apart from condoms on the market yet, one really promising male contraceptive that’s been developed is Vasalgel. A gel is injected into the vas deferens (which is the tube the sperm swim through to get out), blocking the sperm. Like a vasectomy, it’s likely that this method is very effective and will last a long time. But unlike a vasectomy, it’s also very likely to be reversible! A second shot dissolves the gel, returning fertility.

So why isn’t this magic gel on the market? Funding. The company developing it has had a hard time coming up with the money to continue and none of the big pharmaceutical companies want it. Why, you ask? Patriarchy. Greed. You know, the usual BS.

Question: “Why wouldn't my doctor tie my tubes before I was 30? I was ready at 23, but had to wait. I have never wanted children and am very glad I had a tubal ligation three years ago.”

Answer: This is a complaint I’ve heard from a lot of young women and non-binary AFAB (assigned female at birth) people who know that they don’t want children. Unfortunately, it’s pretty common. Despite the fact that there’s no law against voluntary sterilization at any age, many doctors won’t do it for women and non-binary AFAB people who haven’t given birth yet.

Why? Because sexism. Because patriarchy. Because there’s this idea that all women and other people with uteruses want to be mothers because it’s “natural,” even though many don’t. The only advice I can give is to keep trying to find a doctor who will do the procedure for you. They are out there, even if it takes some work. I’m sorry that it has to — it shouldn’t and it’s messed up — but that’s the world we live in.

Question: “How come there's no birth control options for women that don't f*ck their bodies up?”

Answer: I feel this one — hard. It can feel like every single option for women and other people with uteruses is just… bad. Like either you have to deal with acne or depression or loss of libido or super bad cramps or living with a little t-shaped thing inside of you.

But here’s the good news: There are options out there that don’t mess up our bodies. Firstly, plenty of women have little-to-no side effects on pretty much every kind of birth control out there. Does that mean it’s the case for everyone? Nope. But it does mean that just because the Pill messed up your BFF really badly, for example, it doesn’t mean it will do the same to you. So it’s worth trying out a few different methods, in consultation with your doctor, in order to determine the best birth control method for you.

The other good news is that barrier methods — including condoms, diaphragms, cervical caps, and contraceptive sponges and film — do exist! They have varying degrees of effectiveness and there are certainly aspects to each that are less than ideal, depending on what you’re looking for, but they definitely don’t f*ck up women’s bodies. In fact, unless you have an allergy, barrier methods have no negative health effects at all.

Whatever your birth control method, take a second to say, "Thanks, birth control! I'm glad you're around." Because even if it's confusing at times, modern birth control is nothing short of a miracle.