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A Crash Course on Contraception
The majority of college women are sexually active and, therefore, at risk for unwanted pregnancy and sexually transmitted infections (STIs). Even if you're not sexually active, some contraceptives can relieve, reduce or prevent common health problems, including painful periods, acne and heavy menstrual bleeding. Whatever your health need, it's important to be informed and make your reproductive health a priority.
Discovering Your Options
Women have more contraceptive options than ever before. Most teenage women who use contraceptives use hormonal methods, like the "pill," or barrier methods, like condoms.
- Barrier methods include condoms (male and female), diaphragms, the contraceptive sponge and cervical caps. They work by blocking sperm from reaching eggs. Keep in mind, however, diaphragms, sponges and cervical caps do not offer STI protection. These barrier methods should be used with latex condoms as they provide the best protection against STIs.
- Hormonal methods include the contraceptive patch, injectable hormonal contraceptives, vaginal ring and oral contraceptives, popularly known as the "pill." Hormonal options work by stopping your ovaries from releasing eggs each month (a process known as ovulation), so you can't get pregnant. The pill is the most popular hormonal method among women your age. There are many types of birth control pills, which are formulated with synthetic versions of the hormones estrogen and progesterone (progestin) in different combinations and levels. One type of birth control pill doesn't contain any estrogen — it's known as a progestin-only pill. Birth control pills are usually taken once a day. They do not provide any protection against STIs.
- Intrauterine device. Another option is an intrauterine device, or IUD. The IUD is a plastic, T-shaped device that is inserted by a health care professional into the uterus. While very effective at pregnancy prevention, IUDs do not offer any protection against STIs.
- Spermicides are foams or creams that contain chemicals that kill sperm. They are most effective when used with a condom to prevent pregnancy.
Which Method is Right for You?
Here are some questions you should consider when deciding which method of birth control is right for you:
- What is your medical history?
- How easy it is to use?
- How easy it is for you to get? (Note: Many campuses offer free condoms through student health or peer health education programs.)
- Does it protect against STIs?
- How well does it prevent pregnancy?
- What side effects can it cause? Will any of these symptoms (breast tenderness, weight gain, for example) affect my interest in using this method consistently?
Be sure to talk with your health care provider to determine which method of birth control is right for you.
Don't believe the myths about protecting yourself from an unwanted pregnancy: Douching, urinating right after sex, having sex in a certain position or withdrawing ("pulling out") before ejaculation are not effective methods for preventing pregnancy. No matter what anyone tells you, these methods do not work.
Emergency Contraception
You may have heard about "emergency contraception," or emergency birth control, which can prevent pregnancy following unprotected sex. This type of hormonal contraception may be an option to consider if you were forced to have sex, if a condom broke or came off, if your partner didn't pull out in time or you missed two or more birth control pills in a row and had intercourse. It is most commonly available in pill form. The pill has higher doses of hormones than standard oral contraceptive pills.
Emergency contraception should be taken as soon after unprotected intercourse as possible to prevent a potential pregnancy — health care professionals recommend within 72 hours, though it can be effective up to five days later.
Emergency contraception should not be used as regular birth control. If you think you need emergency contraception, talk with your health care professional or call the hotline 1-888-NOT-2LATE to locate a health care professional who can help you. Emergency contraception used to be available by prescription only, but the FDA has just approved Plan B without a prescription. Plan B is expected to be available for purchase over the counter by the end of 2006.
An IUD inserted after unprotected sex can also be used as a form of emergency contraception.
Non-Contraceptive Advantages
Certain types of contraception, namely the pill, provide benefits beyond preventing pregnancy. Birth control pills can help reduce and/or prevent:
- Painful menstrual cramping (dysmenorrhea)
- Heavy or abnormal uterine bleeding
- Iron-deficient anemia often caused by heavy menstrual bleeding or a diet low in iron
- Acne
- Ovarian cysts
- Ovarian and endometrial cancer
- Symptoms of endometriosis such as painful menstrual periods and/or pelvic pain.
- Endometriosis is a condition in which cells from the uterine lining adhere and grow outside the uterus.
Oral contraceptives may also provide some protection against pelvic inflammatory disease, or PID, an infection involving the uterus, fallopian tubes or ovaries caused by bacteria associated with untreated STIs. PID can cause pain and may eventually cause infertility.
Birth control pills may also improve bone density, which is an important consideration for women, who are at greater risk for bone loss.
Most women who choose to use a hormonal method at your age take the pill. Possible side effects include mood changes, headache, nausea, breast tenderness and blood clots (rare in women under 35). Talk with your health care provider about these benefits and side effects and whether the pill might be a good choice for you. Be sure to tell him or her whether you are or have been sexually active since your last visit or if you smoke cigarettes.
Guard Yourself from STIs
Remember, the pill and other hormonal methods do not protect you against STIs. STIs such as chlamydia, gonorrhea or the human papillomavirus (HPV) are highest among women around your age, and they are serious infections. Some can have long-term effects on your reproductive health. Some are treatable, but not curable.
Of course, the most effective way to avoid getting an STI is abstaining from all sexual activity (i.e. oral, vaginal or anal sex). While some students make this choice, many more are sexually active and, therefore, need to know how best to protect themselves and their partners from STIs. In fact, surveys show eight out of 10 college students are sexually active, many have multiple partners and are at risk for STIs.
If you or your friends are sexually active, it is essential to adopt safe sex habits. This includes using a new latex condom every time you have sex. When used properly and consistently, condoms can protect against unwanted pregnancy and are your best bet for guarding against some STIs, including HIV. Use condoms and/or dental dams during oral sex, too. If you use a lubricant, make sure it is water-based (not oil-based), so it doesn't weaken the condom.
Some STIs, including HPV, which is very common among people your age, can be contracted through skin-to-skin contact alone. That means even if you avoid intercourse and use a condom, you're still at risk. Before having sex, talk with your would-be partner about your sexual histories and consider being tested for STIs. You need to be honest about what you need to feel comfortable and confident when engaging in sexual activity.
And, wait awhile after ending a relationship before having sex with a new partner; waiting six months (or more) can provide time for any undiagnosed STI to resolve itself.
If you think you might have an STI or have been exposed to one, call your student health service right away to be screened and treated.
Taking Charge of Your Reproductive Health
It is often during college that young women first take charge of their reproductive health care. Your reproductive health needs change as you get older. For example, you may notice changes in your menstrual flow, or perhaps your cycle is different than it was when you were in high school. Of course, if you are sexually active, it is even more important to talk with your health care provider about contraception choices and STI testing. Be sure to ask about STI screening; don't assume you're getting one automatically during your exam.
You should have an OB/GYN appointment every year. This typically involves having a breast and pelvic exam and Pap smear. Your gynecologist will also ask about your reproductive and general health. This is a good opportunity to bring up any questions you may have about your menstrual cycle, your reproductive health and other related health issues.
Questions to Ask Your Health Care Professional
- I want to take birth control pills. What should I know about them?
- Which type of pill would you prescribe for me? What side effects might I notice?
- Which contraceptive methods will best protect me from STIs if I am sexually active?
- I've been having very heavy, painful periods lately. What can I do to relieve the pain and reduce the bleeding?
- What's the difference between barrier methods like the diaphragm and cervical cap and the vaginal ring?
- Should I have an STI screening before using contraception?
References
Rimsza ME. Sexually Transmitted Infections: New guidelines for an old problem on the college campus. Pediatr Clin North Am. 2005 Feb;52(1)L217-28.
American College of Obstetricians and Gynecologists. Especially for Teens Fact Sheet. www.medem.com. Copyrighted July 2005.
Association of Reproductive Health Professionals. "Health Benefits of Contraceptives." http://www.arhp.org/patienteducation/onlinebrochures/hbc/index.cfm?ID=281 2002.
Jensen JT, Speroff L. Health benefits of oral contraceptives. Obstet Gynecol Clin North Am. 2000 Dec;27(4):705-21.
Centers for Disease Control and Prevention (CDC). "Sexually Transmitted Diseases Treatment Guidelines 2002." www.cdc.gov/STD.
Canales MK, Carr J, Wohlberg J. "It's about time:" College women's perceptions of gynecologic health. J Am Acad Nurse Pract. 2005 Jun;17(6):225-33.
National Women's Health Information Center. "Emergency Contraception" Fact Sheet. womenshealth.gov/faq/econtracep.htm. Last updated May 2006.
Nemours. "Birth Control: IUD." www.kidshealth.org/teen/sexual_health/contraception/contraception_iud.html
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