OP: Which birth control for Me?

The theoretical limit on the number of children a woman can have is sixteen. The record is twenty-seven live births to one woman. The highest rate for a society was an average of twelve children per woman among the Hutterites of Canada in the early twentieth century. That dropped to six by the end of the century. From these numbers it is obvious that throughout history, women have found ways to reduce their fertility – they have practiced some form of conception or birth control.

Documented practices have included avoiding vaginal sex (it is not by coincidence that biblical stories and Egyptian art include withdrawal, anal and oral sex). We know that variants of condoms, intra-uterine devices and chemical potions have been used throughout history. That has not changed; what has changed in the last century is the convenience of regulating pregnancy. Most things available are described in Golden Posts or elsewhere on this site. More information on any form is available through Planned Parenthood or other women’s health sites, your doctor, even your school nurse.

So, you ask, what is best? That, I say, depends. It depends upon your age, sexual activity, marital status, desire for future children, the risk you are willing to live with. The only certain approach is abstention from vaginal sex. There are women with active sex lives who rarely take a penis into their vaginas. Oral, digital and other creative forms of stimulation are used to the exclusion of genital contact. Most of us, while enjoying all these techniques, also want the satisfaction of actually taking a penis into us.

The commercial, convenient approaches can be placed into categories. Barrier methods mechanically prevent sperm from entering our uterus. Chemical methods kill the sperm in our vaginas. Hormonal approaches prevent either ovulation or implantation of the egg in the uterus’ wall. Intra-uterine devices mechanically prevent the egg from implanting itself in the uterine lining. Sterilization stops either the egg or the sperm from the assignation in the fallopian tubes. Some people see the iud and some pills as causing abortion because the fertilization has taken place but the fertilized egg is denied the chance to develop. That interpretation is up to you.

I have personally used all these techniques except the iud. I have recommended or prescribed every one of the approaches. Including, “Don’t!”

The most accessible, economical and convenient is the condom. All the barriers, including condoms, should be used with a spermicide. That is, all the barrier methods are improved by, or require, chemical backup. With the diaphragm or cervical cup, the spermicide is required. The sponge is a barrier that is impregnated with spermicide. Relatively few women continue to use the diaphragm or cervical cap. Some, however, do use the flexible, disposable menstrual cup, filled with vaginal jelly, as a cervical cap. It certainly looks like one, but is deeper. They are not recommended as contraceptive devices and come in only one size. The literature that comes with them does recommend them for use during menstrual sex. Draw your own conclusion, recognizing that there is a possibility that they can be dislodged when a penis gets in there.

The condom plus spermicide is the most common form used by younger women having intermittent sex. When used with added contraception (not just the spermicidal lubricant on them), they are as effective as the pill or other hormonal approaches. This is the approach I recommend most commonly for young women starting their sexual activities. There is no prescription required and both the condoms and various spermicides are easily available. Some women use condoms throughout their lives.

A “recent” addition to the condom is the “female” condom. Actually, the Romans used goat bladders centuries ago as female condoms. The female condom is quite large, has two rings (one inside and one outside the body) and is inserted into the vagina. Spermicide should be placed into the vagina and into the condom. The reason I recommend placing spermicide into condoms (either regular or female) is that most condom failure is not failure of the condom, itself, but leakage around the open end. A bit of spermicide in the condom reduces this risk a bit. Also with the female condom, the penis slides inside the condom and many men feel they are less desensitizing than regular condoms. Lacking a penis, I cannot comment. For the same reason (the penis sliding inside the condom), I find them less realistic. In the vagina, there are no nerve endings, so evidently the friction against my “externals” is somewhat reduced. This will vary among women.

The female condom is comparatively quite expensive. The World Health Organization is presently testing them in some countries for multiple uses. With proper washing and checking, they should work for several uses.

Using spermicides alone is about as effective as using condoms alone. The advantage is that there is no mechanical separation between penis and vaginal wall. If inserted right before the penis, they do not get in the way of oral warm-ups but would require a brief pause for insertion. Spermicides are available as jelly, film, foam or suppository. The jelly and foam require an applicator; the film and suppository a brief wait (longer for the suppository) for the “melting.” While not as effective alone as with a barrier, women for whom pregnancy is not a disaster can take this approach quite conveniently. Perhaps while “coming off” a hormonal system would be an appropriate, temporary use of spermicides alone. Single, young women for whom pregnancy would be more than an inconvenience, should not use spermicides alone. Some couples share the responsibility: the man sometimes uses a condom; the woman, a spermicide.

The sponge is a very popular system combining the barrier (actually, the sponge absorbs the semen) and chemical approaches. The sponge is about as effective as a properly used condom. It is dampened and inserted sometime before the penis. This can be up to hours before or just before – it is immediately effective. Young women for whom pregnancy is highly undesirable may want to use the sponge along with the partner using a condom. For married women, the risks of the sponge alone are probably entirely acceptable.

The most common contraceptives for women in their twenties are hormonal. These are administered as the pill, patch, ring, shot or implant. There are many pills available with different formulations. Most women can find one or another of these systems useful. Often, several must be tried until the ideal is found. A new pill has recently been introduced that reduces menstruation to four periods a year. Which of these systems is chosen is a very individual decision. Each requires prescription and the implant and shot require medical involvement. The patch would have the problems of any adhesive device and the ring should be checked regularly with a finger. If you find the ring among the bed linen, you have a problem. This is not common but is a possibility. During foreplay, the position of the ring can be either checked or adjusted. The biggest advantage of the ring is its very low dosage and it is tolerated by some women who cannot tolerate the other dose rates.

The hormonal systems have very low “failure” rates and represent risks acceptable to most sexually active women. Care must be taken with interactions with other drugs (especially anti-biotics) or dietary supplements. These should be discussed with the doctor prescribing, and other doctors prescribing should be advised what form of birth control you are using.

The intra-uterine device is a surprisingly old and presently under-used approach. For at least 900 years, women on Taiwan have inserted pebbles from a special stream into their uterus. There were problems with one particular iud during the 1980s that have scared many women off. More modern iud’s are very effective and can be tolerated by 95% of all women. The downside is that they require a doctor or nurse to insert and remove them. They have trailing strings to allow you to insure that they are in place. They are nearly as effective as the hormonal systems and are appropriate for most women in their twenties and thirties. For younger women, it is desirable to avoid the hormones and the iud, if you are comfortable asking the doctor, is a very effective backup that your partner may not even be aware of while he continues using condoms.

As women get into their thirties sterilization has become the most common form of contraception. Either the woman has a tubal ligation or her partner has a vasectomy. Choice is up to the couple involved but it always occurs to me that it is the female body that gets pregnant. Enough said. I had my tubes cut when I was thirty. The vasectomy is a simpler, cheaper, lower risk (no general anesthesia) procedure. The ligation protects the body that becomes pregnant. Your choice. Either approach should be considered final. You must be certain that under no circumstances would you want children before you make this decision. Even though there are physicians who specialize and advertise reversal of these procedures, do not count on it. There are infrequent side-effects reported with either procedure and reversing it surgically will not reverse these side effects. They are very rare but should be discussed with the doctor before you make a decision. I have seen none of the side effects in patients I have referred for either of these procedures. About one woman in 10,000 has an unexpected pregnancy after sterilization of either herself or her partner. Newer procedures may be reducing this “healing.”

So, what do I recommend? In my teen aged patients who are sexually active but living at home, I recommend condoms with vaginal jelly. In their late teens, I may suggest an iud while the partner continues to use a condom. In young married women, the recommendation varies. Those who are delaying pregnancy for quite a while should be using an iud or one of the hormonal systems (I prefer the ring for starters). If pregnancy is a matter of convenience and will be wanted in the near future, the sponge or chemical approaches are what I recommend. After all wanted pregnancies are completed, we talk about sterilization, iud or hormonal systems. The decision is theirs.

I still have a few patients using diaphragms because they became comfortable and confident with them and simply do not want to change. One of these women discovered the menstrual cup as a convenient alternative (she went on holiday and forgot her diaphragm) and told me about it. She has been using that for a few years.

The purpose of Chick Chat is exchange of ideas. Bring them on.


Posted: 26 Sep 21:16


> and remember BC pills in the UK are free!
thats so awesome!!
i think they should be everywhere.
its such bullshit in th US. i get mine from my clinic at school for $10 a pack which is MUCH better than getting them from my regular DR where i have to pay full price....like $30 a pack.
i have insurance but most insurances here don't cover BC but they cover pills like Viagra....it doesn't make sense.
argh it pisses me off...


Posted: 26 Sep 21:17

OK Brandye I need some of your expert advice please.

I'm going to be entering a new relationship where I now have to think about BC. My husband was fixed so I haven't dealt with this stuff in 17 years and before that I just used condoms. I was on the pill from the time I was 19 to 21. But I am a smoker and the doc kept freaking on me so I went off of them.

Now, I still smoke but will be quitting when I start living with my new man. (A non-negotiable thing for us both) I am overweight and still need to loose about 40 lbs before reaching my goal. He seems to think I need to be a non-smoker for at least a year before getting on the pill.

I am leary of the pill because I will be 40 when we move in together and I just don't know if that is too old and how long can I realistically be on it?

Condoms will just suck big time and I hate that idea. I did hear the sponge was coming back and wouldn't mind considering that.

He wants me to see a doctor ( no offense but I would rather eat bugs) and discuss my options on what I should do. So, I thought I would discuss it here and see what ideas are out there now.

Any advice would be greatly appreciated. Thanks


Posted: 26 Sep 21:18

Statistically, the preferred method for women over 30 has become tubal ligation. The operation is pretty simple these days. I had mine done back in the days that they went in vaginally and it was a bigger deal. Many clinics do it now on an outpatient basis and you realistically have ten years left needing some sort of protection. That should make it economically feasible. It also gives us girls some "flexibility."

The weight and smoking are your business but I would recommend they each be dealt with. The ring is the newest of the hormonal birth control approaches and it puts less hormoe into the system. I think many women would be happier with that than the pill. It just does not seem to be getting the acceptance that it deserves.

As for the year from smoking to hormones, some doctors will point out that there are more serious consequences from pregnancy than smoking and being on hormones. All of life is choosing the chances you want to take.

Sitting in my office, I would urge that you consider getting the tubes cut. Yes, there are risks with the anesthesia and infection. There risks getting out of bed in the morning.

The sponge is a good choice for women who are delaying or spacing children. Its effectiveness is about the same as condoms - perhaps a little better. If you would not mind another child, the sponge is convenient and has few side effects - same as spermicides. If another child is absolutely out of the question you would want condoms with the sponge.

Personally, after my fince died, the tubal ligation became my big choice and I have not regretted it a bit. You are the one who gets pregnant, so you should be the one protected (rather than a vasectomy for partner). My view.


Posted: 26 Sep 21:19

Thanks for the info Brandye. I do plan to do more research into tubal ligation. We want something that is permanent and he is going to talk to his doc about a vasectomy. That would be the cheaper and faster route. But, due to some past medical problems he is a little gun shy about doing it which I totally understand.

Anyway, thank you very much.


Posted: 26 Sep 21:19


I love that other adults are here and there are some serious questions. You may find some women's health clinics that have very low rates but, you are right, it will not be as fast because of waiting lists. Either one getting trimmed is a good approach for those over about thirty who are certain that no more children will be wanted. Consider either partner's sterilization as permanent.


Posted: 26 Sep 21:19

Question: is there any particular reason you would advise against using hormonal methods (the pill for my case) for a girl late in her teens (19 in this case)?

Is it just generally ill advised or is there medical reasonsfor so?

Currently me and my partner use condoms, but would like the added protection just in case, and the pill appears to be our best option.


Posted: 26 Sep 21:20

im sure brandye will have a better answer.
they usualy don't like to give them to young girls but you are 19 so the age thing is safe.
um if you smoke, its kinda bad.
i smoke and take the pill and my DR is ALWAYS harping on me to quit. im down to like 5-7 a day...i used to be over half a pack.
its hard to quit when you live w/ 2 mates that smoke, but whatever lol.
i think you are pretty much in the clear unless you have certain heart conditions or histories of breast cancer, stuff like that.
when you go see your DR you guys will talk about all that.


Posted: 26 Sep 21:20

Neither of us smoke, or ever have done, and don't take any recreational drugs either.

Only other issue is confidentiality.

Living with parents who are far from open minded (They harped on like crazy over getting a job and a boyfriend before finishing university) little paranoid about any letters/phone calls to home regarding the pill. Are doctors only allowed to address issues to me or are they entitled to go through parents?

Also I live in Britain so may vary from US norms :/


Posted: 26 Sep 21:20

i don't know about there... here you are considered an adult at 18. if you are a minor, things are different.
and DR/patient confidentiality is very important.
besides, id rarely see them just calling your house to ask you question and then blurt out to your parents.
you could always tell the DR to put on your file that they are NOT ALLOWED to discuss anything about you w/ anyone other than you. they might send bills or reminders to your house. ?? not sure if your mom would just be opening your mail or not.

so to answer your question i believe once you are considered an adult the DR are only allowed to go through you.
i go to the clinic at my school so the visits are free and the pills are cheap. usually they cost around $30 in the US and i get them for $10.


Posted: 26 Sep 21:20

Few doctors would hesitate to prescribe the pill for a 19 yo. I have patients that age on the pill and think it is great for them - whether or not married.Down around 16, or even younger, the body is still developing and messing with the hormones is not a good idea.

The other issue is need. At 19 you will predictably have a more active sex life than at 16. I question whether it is worthwhile using hormones for once or twice a month.

The pill has also become a preferred treatment for dysmenorhea (difficult periods). This raises some intersting issues. When I have a mother of a 16 yo demanding that her daughter have the pill for difficult periods, it seems that the mother has just discovered that her baby is screwing. Other mothers go nuts when I recommend the pill for true dysmenorhea because "it will encourage her to have sex."

At nineteen you should have no confidentiality issues. The laws vary by country but unless the doctor is a family firend who may blab to your parents, it should not be an issue. Some doctors will not preescribe for unmarried women under some arbitrary age. Most cities have sex clinics or women's health clinics. Often free. None of these will violate confidentiality, nor would any office of Planned Parenthood.

Short answer: there should be no issue, medical or legal, for a 19 yo woman getting the pill.


Posted: 26 Sep 21:21

hi there, I was just looking for a little advise on the pill... I'm in the UK and was prescribed a brand of pill called ovranette (sp?) when I was 15. I've taken it on and off over the years (for periods of about 8 - 12 months).

I have a regular partner and want to go back on the pill again (besides using a condom, not instead of!). The thing is when I am on the pill it really lowers my sex drive.

In the past when I have gone to the doctors to get put on the pill they have automatically given me this ovranette since i have been prescribed it previously. I have just moved to a new area and since this will be my first appointment with my new doctor I don't know if they are any good or not! Could anyone give me advice on what kind of pill to ask for or maybe some brand names?

Just in case it affects your answer, heres some additional info on me: I'm 21, in a long term relationship, don't smoke, don't drink, not overweight, no other known medical problems.

Also I believe ovranette is an estrogen only pill, I have read on the internet that some women need to take testosterone to increase their sex drive. Does anyone know if there is any truth in this (or if not take testosterone, take less estrogen)?


Posted: 26 Sep 21:22

OK, I am not in the US and I assume you are. Both operations in Europe are usually done in private clinics - that is, not part of our National Health System. Converting to US dollars the cost on the Continent or in the UK would be about 600 for the vasectomy and over 1000 for the ligation.

The tubal ligation costs more because it is done under general anaesthesia rather than the local used for a vasectomy. It is a more invasive procedure and uses more sophisticated equipment. The ligation will use an operating suite while the vasectomy is an "office procedure."

An additional consideration to cost is that it is the female body that gets pregnant. I perform neither procedure but frequently consul with patients. It is each couples decision. Being female, I want the protection. Even though I am not married and in a primary relationship with another bisexual woman, we have both had tubal ligations.

White Tiger,

Tell your new doctor about your experience with ovranette. Talk over what her experience with various pills has been.

Yes, some women do take small doses of testosterone while on the pill. If you get one that really works for you, this is rarely necessary.


Posted: 26 Sep 21:22

I kinda have the same problem as whitetiger. I've taken about 5 different kind of pills since i was 16. Never had a problem with the sex drive because i wasn't really sexually active before i got married about 7 months ago. Now that i am married, i have problems with my sex drive and i know it's because of the pill. So there's no pill that you know of that isn't so harmful on the sex drive?


Posted: 26 Sep 21:22

Sounds like you have tried a few. With a few patients I have moved them to the ring with good results, The ring puts much less hormone into your system and there is less chance of reduced libido. The ring needs to be removed and replaced each month. You do it yourself so once on it you take care of it yourself. If you ever take an antibiotic you must use a backup contraceptive.

Another thing to consider is the IUD. They got a bad rap and are still a very good contraceptive. The doctor inserts the IUD and then you have a regular yearly checkup. Many women have some spotting for a month or so but most tolerate the IUD quite well.

Some doctors are also prescribing small doses of testosterone and that seems to keep the libido up.


Posted: 26 Sep 21:26

My boyfriend and I have been watching this site for a long time and we decided that we should start asking questions with the hope of finding some answers. I also want to inform you all that both of us will be using this loggin and hopefully it wont be to confusing.

So here our story:

We have been together for 7 years, I'm 26 and he is 25 at the start our sex lives was havenly but shortly after we started I went on birth control and ever since then we have noticed a decline in my sex drive. At first I was on Allesse and then for some reason the pharmacist couldnt get anymore in, so I had to goto the doctor and she put me on Linessa. Now it seems I have no sex drive, I have gained alot of weight and severe mood swings specially on my period. I have talk to my doctor and she says my low labido is "A mental problem and I should try to get into the mood" and that all my issues are not from my birthcontrol. I dont believe her.

Now my boyfriend has researched and we believe that all our problems are because of the birth control. He has told me about the Nuvaring but when we looked into the weight gain from it people said they have gained up to 15lbs :( but everything else looked good. Even after 7 years we still use a condom but only for the finally, both of us fear having a kids yet so we try to cut down the chances but plan on having some after we get married.

Now we are begging you for help!
We want my sex drive back and I dont want massive weight gain from the birth control.

What birth control would you all suggest?

I have used the search button and I will be talking to my doctor about Ortho tricyclen but I was wondering what other pills would you all suggest?

Which is better a Triphasic,Biphasic,Monophasic pills?

Thank you all for listening


Posted: 30 Sep 01:08

Any doctor who says that loss of libido is solely a "mental problem" and tells you to just "get over it" is not worth listening to about these matters. Loss of libido has many physical and psychological causes, birth control being one of them.

The birth control I use is Loestrin Fe 1.5/30. It's worked pretty well for me; no weight gain, not much of a libido decrease. It did make my emotions start to swing around more, but that's another one of the most common side effects of any BCP. I don't know if Loestrin is made of similar compounds as Alesse or Linessa though.


Posted: 30 Sep 01:08

Every woman adjusts better to some pills than to others. Some very few do not adjust at all and end up using alternative methods. Generally, the ring has less side-effects for most people simply because there is less hormone in your system. And the weight issue is controllable by the woman. The libido issue may be related dirtectly to pill.

As for which pill is best, that is up to you and your doctor. I do not know your medical history or your family history and would not answer that question without some serious office consultation. Talk to your doctor - or new doctor as the case may be.

The IUD is an underutilized alternative to hormonal approaches and is worth considering. They got a bad rap twenty years ago as a result of serious issues with one design from a single manufacturer. May be worth your consideration.


Posted: 30 Sep 01:09

First thank you for the replies :)
As for my Dr. , My we hate going there because she has been an issue in the past and continues to be so now. One of Canadas biggest problems is a lack of doctors so im stuck with her. I would love to find a more respectable doctor.
Brandye- You seems like you know what your doing would you like to come to Canada hehe.

Brandye- Im not sure if you have talked about this on the forum yet but could you explain to me, Why is it that we gain weight from these pills, even more so with the Ring? I am going to go to my Doctor and talk to her about new pills or even this ring. Lower dose pills should have less effect on my Libido correct? But how less effective are they?

My boyfriend said he will buy us gym memberships and work out with me, so hopefully weight gain can be decreased.

Again thank you for the response and sorry for more questions


Posted: 30 Sep 01:09