Health Matters Fact Sheets – Birth Control: Facts and Fiction

When they hear the term birth control, many women think only about “the pill.” But today there are types of birth control that weren’t available a generation ago.

As with many health care topics, there’s a lot of confusion about birth control. That includes out-of-date information and ideas that are just plain wrong about what works and is safe.

No birth control method is right for all women. Learning about different options can help you choose the one that’s best for you now. (That choice may change over time as your life changes.)

This fact sheet corrects some common myths about birth control, so you can discuss options with your health care provider and make informed choices. Read on to separate the facts from the fiction about birth control.

FALSE:  Birth control pills are the only birth control that relieve menstrual pain.

TRUE:  “The pill” does help with menstrual pain, but so do several other types of birth control.

About 15% of young women ages 13 to 19 have painful periods that keep them from doing their usual activities.^1,2  Menstrual pain is caused by chemicals in the body that help the uterus contract. For some women, the result can be painful periods.¹ Birth control pills can relieve this pain.^3,4 So can several other methods, such as:

• The contraceptive ring and patch both work in the same way as the pill.
• Extended-cycle birth control pills. They reduce the number of periods you have.^1-5  You can use the ring or patch in extended-cycles too.^1,6
• Depo-Provera shot. This is a shot that’s given every 3 months.¹
• The LNG intrauterine contraceptive system.¹ (LNG is short for levonorgestrel, the hormone it uses.)

FALSE:  Intrauterine contraception (IUC) makes it harder for women to become pregnant when they want to because it raises the risk of pelvic infections.

TRUE:  Infection risk with IUCs is very low and lasts only a short time. Pregnancy rates are the same for women who have used an IUC and those who haven’t.

Early studies seemed to show a connection between IUCs and greater risk for pelvic infections and problems getting pregnant.¹ Now we know that the risk of an infection is small, and that this is related to the placement of the IUC and lasts for about 20 days after insertion.⁷ After that time, infection risk is very low and stays low for many years.^1,8-13 We also know that IUCs don’t increase risks of infertility.^1,14-16 However, if you already have an active pelvic or cervical infection or may be pregnant, you shouldn’t use an IUC.

FALSE:  Young women and women who’ve never had a baby can’t use IUC.

TRUE:  Most women can use IUCs. That includes young women, women who haven’t had a baby, women with multiple sexual partners, women who’ve had an ectopic (tubal) pregnancy, and women who’ve had pelvic inflammatory disease in the past.

IUCs are underused in the United States, especially by young women 13 to 19 years old. Because this age group has a higher risk of unintended pregnancy, IUCs are a good birth control choice.¹⁷ Once they’re inserted, they require no care except routine checking to make sure they’re in place. Most women can comfortably use an IUC, and placement is almost always successful the first time.^1,7-9,18,19

FALSE:  Birth control pills don’t work for women who are overweight or obese.

TRUE:  When they’re used correctly, birth control pills are very effective for overweight and obese women.

Some studies show that a high body weight or body mass index (BMI) may reduce the effectiveness of birth control pills. But birth control pills lower pregnancy risk much more than “barrier methods” like condoms—and, of course, much more than not using any birth control at all.^20-24 A recent review found that high body weight or BMI doesn’t decrease the effectiveness of other hormonal birth control methods such as implants, intrauterine devices (IUDs), and shots.²⁵ If you choose the birth control pill, remember that its effectiveness depends on using it correctly and consistently regardless of your weight.

FALSE:  Birth control methods don’t improve the symptoms of perimenopause.

TRUE:  Hormonal birth control helps improve some symptoms of perimenopause, including heavy or irregular bleeding and hot flashes.

Perimenopause is the time leading up to menopause when female hormones and the menstrual cycle start to change. Perimenopause can last several years. During this time, women can still become pregnant. If you’re healthy, normal weight, and don’t smoke, you can safely use the pill, contraceptive patch, and vaginal ring until menopause.¹ These methods help control bleeding and hot flashes.^1,26
Important: The risk of blood clots rises with age. Obesity and high levels of blood fats like cholesterol make this effect worse. If you know or think you’re in perimenopause, it’s a good idea to discuss the risk and benefits of combined hormonal birth control with your health care provider.^1,27

References

• Hatcher RA, Trussell J, Nelson AL, et al. (eds). Contraceptive Technology: Twentieth Revised Edition. New York NY: Ardent Media; 2011.
• Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. 1982;144:655–60.
• Davis AR, Westhoff C, O’Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: A randomized trial. Obstet Gynecol. 2005;106(1):97–104.
• Harada T, Momoeda M, Terakawa N, et al. Evaluation of a low-dose oral contraceptive pill for primary dysmenorrhea: A placebo-controlled, double-blind, randomized trial. Fertil Steril. 2011;95(6):1928–31.
• Coffee AL, Sulak PJ, Kuehl TJ. Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen. Contraception. 2007;75(6):444–9.
• Miller L, Verhoeven CH, Hout J. Extended regimens of the contraceptive vaginal ring: A randomized trial. Obstet Gynecol. 2005;106(3):473–82.
• Gold MA, Johnson LM. Intrauterine devices and adolescents. Curr Opin Obstet Gynecol. 2008;20(5):464–9.
• ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 59, January 2005. Intrauterine device. Obstet Gynecol. 2005;105(1):223–32.
• Penney G, Brechin S, de Souza A, et al. FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care. 2004;30(1):29–41.
• Walsh T, Grimes D, Frezieres R, et al. Randomised controlled trial of prophylactic antibiotics before insertion of intrauterine devices. IUD Study Group. Lancet. 1998;351(9108):1005–8.
• Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and pelvic inflammatory disease: An international perspective. Lancet. 1992;339(8796):785–8.
• Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356(9234):1013–9.
• Grimes DA, Schulz KF. Prophylactic antibiotics for intrauterine device insertion: A metaanalysis of the randomized controlled trials. Contraception. 1999;60(2):57–63.
• Wilson JC. A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: A four-year study. Am J Obstet Gynecol. 1989;160(2):391–6.
• Skjeldestad F, Bratt H. Fertility after complicated and non-complicated use of IUDs. A controlled prospective study. Adv Contracept. 1988;4(3):179–84.
• Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345(8):561–7.
• Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. ACOG Committee Opinion No. 450, American College of Obstetricians and Gynecologists. Obstet Gynecol. 2009;114(6):1434–8.
• Bayer LL, Jensen JT, Li H, et al. Adolescent experience with intrauterine device insertion and use: A retrospective cohort study. Contraception. 2012 May 4. [Epub ahead of print]
• Brockmeyer A, Kishen M, Webb A. Experience of IUD/IUS insertions and clinical performance in nulliparous women–a pilot study. Eur J Contracept Reprod Health Care. 2008;13(3):248–54.
• Holt VL, Scholes D, Wicklund KG, et al. Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol. 2005;105:46–52.
• Holt VL, Cushing-Haugen KL, Daling JR. Body weight and risk of oral contraceptive failure. Obstet Gynecol. 2002;99:820–7.
• Grubb GS, Moore D, Anderson NG. Pre-introductory clinical trials of Norplant implants: A comparison of seventeen countries’ experience. Contraception. 1995;52:287–96.
• Gu S, Sivin I, Du M, et al. Effectiveness of Norplant implants through seven years: A large-scale study in China. Contraception. 1995;52:99–103.
• Zieman M, Guillebaud J, Weisberg E, et al. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: The analysis of pooled data. Fertil Steril. 2002;77:S13–8.
• Lopez LM, Grimes DA, Chen-Mok M, et al. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev. 2010;(7):CD008452.
• Hardman SM, Gebbie AE. Hormonal contraceptive regimens in the perimenopause. Maturitas. 2009;63(3):204–12.
• ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2006;107:1453–72