How To Talk About Birth Control With Your Doctor

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New to the world of contraceptives and not sure where to start? We have you covered

Options. You can never have too many. That is, until you’re faced with having to choose a method of birth control. Should you go for the pill or an IUD? Condoms or an intravaginal ring?

To help you decide on the best type of contraceptive for you (and get the most out of it), we spoke with Dr. Kristin Terenzi, a family doctor based in Vaughan, Ont., for a simple primer on contraceptives and the top questions you should ask your doctor before starting or switching your birth control.

Dr. Kristin Terenzi

What are contraceptives?

Contraceptives are agents that prevent pregnancy ranging from physical barriers like condoms to chemical barriers like the birth control pill and even the intravaginal ring and IUD (intrauterine device), which are a combination of both.

How do you decide what type of contraceptive is right for you?

That’s always a personal choice. Some women want [an option] they never have to remember [to take], like an IUD, but some prefer the pill because of its added benefits, like cycle control and improving cramps—it can even help improve acne.

How effective are oral contraceptives?

Oral contraceptives are one of the best forms of birth control if they’re taken appropriately. In a perfect world they’re about 99 per cent effective, but if you miss pills pregnancy can occur, making the effectiveness about 96 per cent. IUDs, on the other hand, are around 98 to 99 per cent effective, but they come with side effects like bleeding and pain with insertion.

How do birth control pills work?

They inhibit ovulation, so if there’s no egg you can’t get pregnant. They make the cervical mucus very hostile to sperm, and they also change the lining of the uterus to inhibit pregnancy.

Which hormones are found in the pill?

Usually a combination of a progesterone and estrogen derivative. The amounts of those hormones and how they’re delivered—whether continuously or gradually per week—will determine the type of pill.

Who is the ideal candidate for oral contraceptives?

Women up to the age of 35 who don’t smoke, have never had a blood clot, don’t have breast or liver cancer, have no heart disease and don’t have migraine headaches are ideal for the birth control pill. All of these conditions can increase the risk of side effects with the pill.

Are there any other side effects of the pill?

Some can cause breakthrough bleeding—bleeding when you’re not supposed to—which is very annoying but can be managed by talking with your doctor and switching to a different pill.

How do you assess if a contraceptive is a good fit for a patient?

I give my patients a three-month prescription and I ask if they had any headaches, how their periods have been and if they’ve had breakthrough bleeding. Women hate breakthrough bleeding, so I try to deal with that preferably before or even after they have any problems with the pill.

How can somebody talk to their doctor about starting the pill or switching to another type of pill?

I’m a big believer in being able to talk to your doctor about anything. Express what [you] want—and don’t want—from a contraceptive. Make it clear what you’re looking for, whether that’s less cramping, lighter periods, or just a reliable form of birth control that won’t cause breakthrough bleeding. I’m a proponent of name-brand medications, especially birth control. I want an unwavering amount of drug that is not always present in generics, unfortunately. If you can afford it, I usually tell women to speak to their primary care physician about a name-brand medication. And if you have side effects, don’t stay silent. Tell your doctor what’s happening. Don’t settle for cycles that aren’t well-controlled and a pill that’s not doing all that you want it to do.