Dr. Colleen Krajewski debunks the myths surrounding birth control.
Not quite ready for the pitter patter of little feet?
Turns out, birth control — when used correctly — does more than delay your dance with dirty diapers and midnight feedings. It also allows you to set aside the fear of pregnancy and focus solely on your partner and your pleasure during sex.
Here, Colleen Krajewski, MD, MPH, a Bedsider medical expert and assistant professor at the University of Pittsburgh who specializes in family planning, delves into the inaccuracies surrounding birth control and explains why the pill will not cause infertility. We repeat. The pill will not cause infertility.
YourTango: Seven in ten pregnancies to young single women are unplanned. With an abundance of resources available, why do you believe that number is still so high?
Dr. Colleen Krajewski: I spend a lot of time thinking about this, and there’s not a simple answer!
On a broad level, there’s actually not great access to the most effective and best birth control methods — IUDs and the subdermal implant. Even pills can be hard to get, between having a physician to prescribe them and getting to the pharmacy for refills on time!
Research done by the Contraceptive Choice Project showed that when women were offered any birth control method for free and were educated about their options, more women choose the most effective methods — and those who did had lower rates of unplanned pregnancy.
Individual women have different barriers to effective contraception, and that’s what I address once someone’s in my office. For example, many women have the misperception that they are infertile, or they are using a common method that they believe is very effective (like a pill or condom) and that’s not always the case.
Lastly, I find many women don't think they need birth control, since they’re not in a serious relationship. But that’s exactly the time you don’t want to get pregnant, right? Ladies, there is NO shame in using contraception! There are so many factors early in a relationship that are unpredictable, but birth control is one aspect we can control (pun intended).
YourTango: What's the most common misconception about birth control amongst women in their twenties?
Dr. Colleen Krajewski: Thanks for asking — there are SO many! I find that many women have misconceptions about the IUD. They think they’re not a ‘candidate’ for it, but the fact is that the IUD is a great birth control option for just about anyone, whether you’re young, old(er!), have had children, or haven’t.
The other misconception I hear MANY versions of is that a pill can cause infertility. And many of my patients believe that there’s a ‘grace period’ of time after stopping the pill when you still can’t get pregnant. Let me say this clearly: If you stop using your birth control method, you’re at risk for pregnancy.
YourTango: Which forms of birth control are most effective for young professional women?
Dr. Colleen Krajewski: A young professional woman probably wants extremely reliable birth control, and for that reason a lot of my patients will choose an IUD or the contraceptive implant. If heavy periods are a concern, or are difficult to work with (long hours, few bathroom breaks!), many professional women will choose a progestin IUD since it decreases or even stops a woman’s period.
YourTango: Talk to us about emergency contraceptives. How soon after sex should you use them, and when are they least effective?
Dr. Colleen Krajewski: There are three options for EC (emergency contraception): a ParaGard IUD, ella, and Plan B. For any of these, earlier is better.
The most effective EC option is the ParaGard, and you have up to five days to use it, but it needs to be inserted by a medical provider. The up-side to this is that you can keep it in for up to twelve years if you want (though remember you need to take it out if you want to get pregnant).
Ella is prescription only, so it’s a good idea to get it before you need it. There are lots of things we keep in our house in case of emergency — add ella to the list! It can be taken up to five days after unprotected intercourse.
Plan B is available over-the-counter, and is also effective up to five days after sex (though the label says three). This Bedsider article has more detail about the logistics of getting/taking it. It’s also important to note that research has found that Plan B may not work as well for women who weigh over 165 lbs.
YourTango: Should women 35 and older stop taking the pill? If so, what are better options for them?
Dr. Colleen Krajewski: By ‘the pill’ I’m assuming you mean the common ‘combination’ pill, which gets its name because it contains both estrogen and progestin. You have probably figured this out by now, but I don’t use a lot of pills in my practice, since they have a 1/10 failure rate for an average woman.
Another possible issue with combination pills—and the patch and the ring, which also contain estrogen—is that estrogen slightly increases a woman’s risk of a blood clot. In a young, healthy woman this risk is still very, very small, but when combined with other factors — like smoking, high blood pressure, migraine headaches, or age — this risk becomes more significant. Not all women over 35 need to stop using estrogen-containing contraception, but some might, depending on what else is going on (smoking, for example). This is why it’s good to go to the doctor yearly!
I’d also like to clear something up about ‘hormones’ and risk of blood clots. It’s usually ESTROGEN that’s risky with certain medical conditions, but methods that only contain progestin — like the shot, progestin IUD, and the implant — don’t affect the risk of blood clots at all.
YourTango: Is it safe to take the pill while breastfeeding? If not, what is a better option?
Dr. Colleen Krajewski: Again, I’m assuming you’re asking about a combination pill (estrogen plus progestin). It’s not a great idea to use a method with estrogen immediately after having a baby because pregnancy and childbirth also increase your risk of blood clots, but there are plenty of other options that women can use right after giving birth.
After the initial postpartum period, it’s safe to take pills while breastfeeding. But again, there may be lower maintenance, more effective options!
YourTango: Please clear up the misinformation that some birth control methods can lead to infertility.
Dr. Colleen Krajewski: Short answer: Other than sterilization, NO birth control method leads to infertility! Not IUDs, not the pill, not the ring. That also means that if you’re on birth control and you stop using your method, you should assume you’re at risk of pregnancy. It’s that simple. Some methods, like the shot, can have a delayed return to fertility for some women. Even so, you can’t trust you’ll be one of those women. And with most methods, you return to full fertility right away. No ‘grace period’!
YourTango: Would you say that women who take an active role in their reproductive health enjoy better sex lives?
Dr. Colleen Krajewski: In general, my patients tell me that the fear of becoming pregnant can inhibit them from truly enjoying intimacy with their partner. I have so many women who tell me they feel so relieved after starting a reliable method of birth control that they are able to focus on other things during intimate moments. Being on birth control does NOT make women more promiscuous, but it can certainly make sex with the partner you choose less stressful and more enjoyable.
YourTango: And what about beyond your sex life. How else can taking control of your reproductive health impact your life?
Dr. Colleen Krajewski: When women are in control of their reproductive health, they're able to do great things. For some women, this means completing their education. For others, it means saving money to travel or to buy a house or car. And when it comes time for pregnancy, it means a woman is able to choose who it's going to be with!
Bedsider.org is passionate about helping women take an active role in their reproductive health by helping them find the method that's right for them and learn how to use it consistently and effectively.