Birth Control#

There are two ways to measure how well a method works:

• Perfect use = used exactly as instructed every single time.
• Typical use = how it actually performs with the occasional missed pill, late patch change, etc.

The bigger the gap between perfect and typical, the more the method depends on you remembering.

IUDs, implants, and permanent surgery have the smallest gap between perfect and typical use because they don't depend on you doing anything daily.

• What you want your periods to do - most hormonal methods make periods lighter; the hormonal IUD, the shot, and the combined pill taken continuously often eliminate periods entirely. The copper IUD typically makes periods heavier.
• Side benefits - combined pills can improve acne and unwanted hair growth.
• Future fertility plans - most methods reverse within 1-3 months of stopping. The shot is the exception (up to 12 months).
• Cost and coverage - varies by method and insurance (see Cost and coverage below).
• Medical conditions that rule out estrogen - some conditions (migraines with aura, blood-clot history, high blood pressure, smokers over 35) mean estrogen-containing methods are not used. Estrogen-free options work for these patients.

A clinician will walk through these with you in your consultation.

Take your pill at the same time every day to maintain effectiveness. Aligning with a daily routine (breakfast, brushing teeth, bedtime) helps consistency.

• 28-day packs - take one pill daily for 28 days. The first 21 (or 24) pills contain hormones; the last 7 (or 4) are inactive ("placebo"). Your period should start during the inactive pills. Begin a new pack right after finishing the last pill, even if your period is still going.
• 21-day packs - take one pill daily for 21 days, then stop for 7 days. Your period should start during the break. Begin a new pack after the 7-day break.

Delaying the start of a new pack (or extending the hormone-free week) increases the chance of pregnancy.

These instructions apply to combined birth control pills containing estrogen + progestin.

If you frequently miss pills, talk to your clinician about a longer-acting method that does not require daily dosing.

No - the pill prevents pregnancy but does not protect against STIs. If you have new or multiple partners, regular STI testing through TeleTest is recommended alongside the pill.

If you vomit within 24 hours after taking an active combined pill, keep taking your pills daily at the usual time. Taking an extra pill is usually not necessary. If vomiting or severe diarrhea continues for 48 hours or more, keep taking your pills if you can, but use backup contraception until you have taken active pills for 7 days after the vomiting or diarrhea has resolved.

Brief diarrhea usually does not affect the pill. Severe diarrhea lasting 48 hours or more can reduce absorption. Keep taking your pills if you can, and use backup contraception until you have taken active pills for 7 days after the diarrhea has resolved.

Most antibiotics do not reduce pill effectiveness - this is a long-standing myth. The only exceptions are rifamycin-class antibiotics (used for tuberculosis and a few other infections) and certain seizure medications.

No. There is no medical benefit to "pill breaks." Many people take the pill safely for years or decades without interruption.

No. Fertility returns to your age-appropriate baseline within 1-3 months of stopping.

It depends on when you started. If you started on day 1 of your period, you're protected right away. If you started later in your cycle, use backup contraception for the first 7 days.

Yes. Alcohol does not interfere with how the pill works. The one indirect risk is forgetting to take a pill after drinking, or vomiting if you drink heavily - if you vomit within 2 hours of taking a pill, treat it as a missed pill.

No harm done. Just resume the schedule the next day and you'll finish the pack a day early. Start the next pack on its normal day. Some patients feel mildly nauseated after two pills - this passes.

No - as long as you take all the active pills correctly, you are protected through the placebo week too. The placebo week is built into the design.

Yes - this is easy and safe. Skip the placebo pills and start the active pills of the next pack right away. Continue until you're ready to have your period, then take a 4-7 day break. See Continuous use below for more.

It depends. Combined pills are generally avoided if blood pressure is consistently high (140/90 or higher). Borderline readings need a clinician's review - sometimes a progesterone-only method is preferred. Mention any blood pressure history in the consultation.

Mood changes are reported but trials have not shown the pill causes clinically meaningful depression on average. A small number of patients do feel their mood worsens on a particular formulation - switching the progestin class often helps. If you have a history of depression, especially severe or postpartum, mention it in the consultation.

Some patients notice lower sex drive on the pill. Switching to a different progestin class often improves this. If libido drops significantly and doesn't recover, talk to a clinician about other methods.

A small temporary increase in breast size or tenderness in the first 1-3 months is common. Most patients see no lasting change.

Rarely. Most combined pills are neutral or beneficial for hair (especially formulations with anti-androgenic progestins). A small number of patients report hair thinning - switching the progestin class usually resolves it.

Most medications don't interact with the pill. Important exceptions: rifamycin-class antibiotics, certain seizure medications (e.g., carbamazepine, phenytoin), some HIV antiretrovirals, and St. John's wort can all reduce pill effectiveness. Mention every medication and supplement you take in your consultation.

If you're between active pills (mid-pack), don't stop - call your pharmacy for an emergency supply. Most pharmacies in Canada can provide a small bridging supply pending a new prescription. If you're between packs (placebo week), starting the new pack a day or two late is generally OK but use backup contraception for 7 days once you restart.

Only if you start on day 1 of your period. Any other start day means you need backup contraception for 7 days.

Yes. Long-term studies have not shown any extra risk from continuous pill use compared with the traditional 21-on/7-off cycle. The monthly "period" on the pill isn't a real period - it's a withdrawal bleed from stopping the hormones. Skipping it has no medical downside.

Continuous use does not:

• Cause backed-up blood or "build up" in the uterus.
• Reduce future fertility.
• Increase cancer risk.
• Affect the pill's ability to prevent pregnancy (it's the same or slightly better).

• Use a monophasic combined pill (every active pill in the pack has the same hormone dose - the standard for continuous use).
• When you reach the end of a pack, skip the placebo (sugar) pills and start the active pills of the next pack right away.
• Continue as long as you like - many people do this for months or years.
• If you want a period occasionally, take a 4-7 day break from active pills to allow a withdrawal bleed, then restart.

Breakthrough bleeding (spotting) is common in the first 3-6 months of continuous use, then usually settles. If spotting continues to bother you:

• Take a 4-day break from active pills to allow a withdrawal bleed, then restart. This often "resets" the lining.
• Take the pill at the same time every day - drifting times worsens spotting.
• Talk to your clinician about a pill with higher estrogen if spotting persists.

• Vaginal ring - can be used continuously by replacing the ring every 21-28 days without the 7-day break.
• Patch - can be used continuously by replacing the patch every week with no patch-free week.
• Hormonal IUD - typically results in lighter periods or no periods over time without any "continuous use" effort.
• Arm implant and birth control shot - often result in lighter or absent periods without action on your part.

PMS = mild to moderate physical and mood symptoms in the week before periods (bloating, breast tenderness, mood swings, fatigue) that don't significantly disrupt daily life.

PMDD = severe mood symptoms (deep depression, anxiety, irritability, anger, hopelessness, feeling out of control) that consistently happen in the 1-2 weeks before periods and significantly disrupt work, school, relationships, or daily function. Symptoms ease within a few days of bleeding starting.

Diagnosis usually requires tracking symptoms across at least 2 menstrual cycles to confirm the timing pattern. Apps that log daily mood against your cycle are useful for this.

Combined pills work by suppressing ovulation. Because PMDD is driven by the brain's sensitivity to the natural hormone swings around ovulation and the luteal phase, suppressing those swings can dramatically reduce PMDD symptoms.

Two important points:

• Not every combined pill works for PMDD. A commonly used first-choice option is a combined pill with an anti-androgenic progestin and a shortened hormone-free interval (24 active pills + 4 placebo, rather than the standard 21 + 7). This formulation has the best evidence among combined pills for PMDD symptoms and is often chosen first when estrogen is safe.
• Continuous (no-break) use of combined pills is often added because removing the hormone-free interval entirely can further reduce mood symptoms.

A clinician will discuss which formulation and dosing schedule fits your situation.

Most patients notice improvement within 1-3 menstrual cycles on the right combined pill. If there's no meaningful improvement after 3 cycles, your clinician will reassess - options include trying continuous use, switching formulations, or adding another treatment.

Other PMDD treatments can work alongside or instead of combined pills:

• SSRI antidepressants - taken daily or only in the 2 weeks before periods (luteal-phase dosing). Often combined with the pill.
• Cognitive behavioural therapy (CBT) - specifically tailored for PMDD.
• Lifestyle measures - regular exercise, sleep hygiene, calcium supplementation, and reducing alcohol/caffeine help many patients.
• Specialist referral - for severe PMDD that doesn't respond to first-line treatments, a referral to a gynaecologist or psychiatrist may be appropriate.

If combined pills plus lifestyle measures don't provide enough relief, talk to your clinician about adding an SSRI or a specialist consultation.

If estrogen-containing methods are not safe for you (e.g., history of blood clots, migraine with aura, uncontrolled high blood pressure), the combined-pill PMDD treatment is not appropriate. Alternatives include SSRIs (often the most evidence-based alternative for PMDD without combined pills), progesterone-only methods (less reliable for PMDD but worth discussing), and specialist input. Your clinician will guide you.

Yes. Request a Birth Control Prescription consultation and mention PMDD specifically in your intake. The clinician will choose a combined pill formulation appropriate for PMDD and discuss whether continuous use is right for you. If your symptoms are severe or have not responded to combined pills before, the clinician may recommend additional treatments or a specialist referral.

• Give it 2-3 months before switching. Most side effects settle as your body adjusts.
• Switching between combined pills, or from a pill to a patch or ring - start the new method the day after finishing the active pills of your current pack. No break, no backup needed.
• Switching to an IUD, implant, or injection - start the new method on the day of your last active pill, with backup contraception for 7 days.
• Switching from an estrogen-containing method to a progesterone-only pill - start the new pill the day after your last active pill. No break.

• New severe headache, vision changes, or weakness on one side - go to the emergency department (see urgent care).
• New or worsening depression that affects daily function - talk to a clinician promptly.
• Heavy bleeding that soaks through a pad every 1-2 hours, or bleeding with lightheadedness or dizziness.
• New or worsening severe abdominal pain.

For anything in this list, do not switch on your own - see in-person care first.

A migraine aura is a specific neurological event that comes before the headache. To meet criteria, all of these need to be true:

1. Timing - before the headache, not during it. Aura symptoms start in the 5-60 minutes before the headache pain, and resolve as the headache begins (or shortly after).
2. Duration - 5 to 60 minutes per symptom. Each individual aura symptom lasts at least 5 minutes and no more than 60 minutes. Brief flashes lasting seconds do not count.
3. Gradual onset - spreads over at least 5 minutes. Aura builds up gradually (e.g., a small blind spot that slowly grows over several minutes). Sudden, immediate vision changes are usually not aura.
4. Fully reversible. The aura symptom completely resolves between attacks.
5. One or more of these specific symptom types:
   • Visual aura - zigzag lines, shimmering shapes, blind spots that grow over time, "C-shaped" or arc-shaped vision loss in part of one eye's field, flashing lights that move across the visual field.
   • Sensory aura - tingling or numbness that spreads gradually across one side of the face, lips, tongue, or arm.
   • Speech or language aura - difficulty finding words or articulating, lasting up to an hour.
   • Motor aura - weakness in a muscle group (rare; called "hemiplegic migraine").

• Blurry vision during a headache. Most blurry vision happens during the headache, not before. This is from squinting, light sensitivity, or general discomfort - not aura.
• Brief floaters or flashes lasting seconds. Aura visual symptoms last at least 5 minutes per symptom. Floaters and brief flashes are usually unrelated to aura.
• Sensitivity to bright light. Light sensitivity (photophobia) is a migraine symptom, not aura.
• Mild dizziness or "feeling off" before a headache. This is usually a "prodrome" - a general pre-headache feeling that can include mood changes, food cravings, or fatigue. Prodrome is not aura.
• Sudden severe vision loss. Sudden, immediate vision loss is not aura - aura spreads gradually. Sudden vision loss can be a medical emergency and needs in-person assessment urgently.

Combined hormonal methods slightly increase the risk of blood clots and arterial events such as stroke. The absolute risk is low in healthy non-smokers, but migraine with aura independently increases stroke risk, so estrogen-containing methods are avoided when aura is present.

Migraine without aura is treated differently from migraine with aura. Combined hormonal methods may be acceptable in otherwise low-risk patients with migraine without aura, but the clinician still considers age, smoking, blood pressure, and other stroke or clot risk factors.

Mention it in your TeleTest consultation. The clinician will ask specific questions to sort it out - timing relative to the headache, duration, what the symptoms look like, and how they evolve. If aura is uncertain or your symptoms don't clearly meet criteria, the safest path is usually to start with an estrogen-free method while you track your headaches more carefully or see a neurologist for assessment.

Suitable estrogen-free options:

• Progesterone-only pill (the newer 24-hour-window pill is a great fit for most patients - see Progesterone-only pill).
• Hormonal IUD.
• Copper IUD (hormone-free entirely).
• Arm implant.
• Birth control shot.

You can still have effective contraception. All estrogen-free methods are appropriate:

• Progesterone-only pill - daily pill, no estrogen.
• Hormonal IUD - 5-8 years, lighter or no periods.
• Copper IUD - 5-10 years, hormone-free.
• Arm implant - 3 years, very effective.
• Birth control shot - every 3 months.

Any of these can be prescribed through TeleTest.

• People who cannot take estrogen (see Who should NOT take estrogen-containing methods).
• People who want to avoid estrogen-related side effects (nausea, breast tenderness, mood effects).
• People who are breastfeeding - progesterone-only pills don't affect milk supply.
• People who want a pill but prefer the 24-hour missed-dose window (the newer progesterone-only pill).

Progesterone-only pills are safe for many patients who cannot take estrogen, but they are not appropriate for everyone. A clinician should review your history carefully if you have:

• Current breast cancer.
• Past breast cancer.
• Severe liver disease, liver cancer, or a specific benign liver tumour called hepatocellular adenoma.
• Unexplained vaginal bleeding that has not been assessed.
• A history of stroke, heart disease, complicated diabetes, lupus, or major cardiovascular risk factors.
• Certain bariatric surgeries that may affect medication absorption.
• Medications that reduce progestin levels, including rifamycin-class antibiotics, certain seizure medications, some HIV medications, and St. John's wort.

Some of these are not absolute "never use" situations, but they require individualized clinician review before prescribing.

The older progesterone-only pill works mainly by thickening cervical mucus, which takes about 24 hours to build up. If you're more than 3 hours late, the mucus thins out and a window for pregnancy opens. The newer progesterone-only pill also suppresses ovulation, so a missed dose is less risky - that's why it has the more forgiving 24-hour window.

Often, yes - particularly with the newer 24-hour-window pill. Some patients have irregular spotting; others have no periods at all. Both are normal and not harmful.

Yes - the progesterone-only pill is safe during breastfeeding and does not affect milk supply.

Yes - typical-use effectiveness is about the same (around 91%).

Less reliably than the combined pill. If acne is a priority and estrogen is safe for you, a combined pill with an anti-androgenic progestin is usually a better choice.

No.

Bleeding patterns vary widely. About one-third of patients have no periods, one-third have lighter regular periods, and one-third have irregular spotting. The pattern in the first 3 months usually predicts what you'll have longer-term. None of these patterns are harmful.

Yes. The newer 24-hour-window pill is often a better choice if you find the older 3-hour window stressful. Switching is straightforward - start the new pill the day after stopping the old one. No break and no backup contraception needed if you switch directly.

Yes - the same medications that can reduce combined-pill effectiveness can affect progesterone-only pills: rifamycin-class antibiotics, certain seizure medications, and St. John's wort. Mention every medication and supplement in your consultation.

The progesterone-only pill is taken every day without a placebo week, so there's no built-in "delay" mechanism. Many patients on the newer 24-hour-window pill have very light or absent periods anyway. If period timing matters for a specific event, switching briefly to a combined pill is sometimes done - discuss with a clinician.

• Start - apply on the first day of your period (or the first Sunday after your period starts).
• Weekly - wear the patch for 7 days, then replace with a new one on the same day of the week (your "Patch Change Day"). Do this for 3 weeks.
• Cycle - in the fourth week, do not wear a patch. You should have your period during this week.

Apply to clean, dry skin on your buttock, abdomen, upper outer arm, or upper torso (not on your breasts). Avoid areas that are red, irritated, or cut.

• Off for less than 24 hours - try to reapply (if still sticky) or apply a new one immediately. Continue your cycle as usual.
• Off for more than 24 hours - start a new cycle with a new patch and use backup contraception for the first 7 days.

• Week 1 (forgot to start) - apply a new patch as soon as you remember. Use backup contraception for 7 days.
• Week 2 or 3 (forgot to replace) - if less than 48 hours, replace immediately and keep your usual Patch Change Day. If more than 48 hours, start a new cycle with a new patch and use backup contraception for 7 days.
• Week 4 (forgot to remove the patch-free week) - remove it when you remember and start the next cycle on your usual Patch Change Day.

The patch passes hormones into breast milk and can reduce milk supply. Estrogen-containing methods are generally avoided while breastfeeding. Talk to your clinician about a progesterone-only option.

Yes. The patch is waterproof and is designed to stay on through showers, baths, swimming, hot tubs, and saunas. Check the edges daily to make sure they haven't lifted.

Most patients have no issue with exercise or sweating. Apply to clean, dry skin and avoid lotion, oil, or sunscreen at the application site.

On the buttock, abdomen, upper outer arm, or upper torso - not on the breast. Most people pick a spot that's easily covered by clothing.

The patch is about 4-5 cm square and beige in colour. It's visible if your skin is exposed, but most people place it where clothing hides it.

No. Cutting the patch changes how the hormone is released and is not safe. If skin irritation is persistent, ask about switching to a different method.

Yes. The patch itself isn't damaged by UV, but tanning lotion or oil at the site can stop it sticking.

Some patients notice mild redness or a faint outline after a patch is removed. This usually fades within a few days. Rotate the site each week to reduce irritation.

Yes - the patch delivers an estrogen and a progestin, similar to a combined pill. The medical conditions ruling out combined pills also rule out the patch.

Mild sunburn is usually fine - leave the patch on. Severe sunburn or blistering at the patch site is a reason to remove the patch and apply a fresh one to a different (unaffected) area; use backup contraception for 7 days if it's been off for more than 24 hours.

The patch contains no metal but does have a thin metallic backing - remove the patch before the MRI and apply a new one to the same or a different site afterwards.

No.

No. Fertility returns within 1-3 months of stopping.

The patch is designed to stay on continuously. Removing it for short periods isn't recommended because it can lose stickiness and you may forget to replace it. If you really need to remove it (e.g., visible at a wedding), you can apply a new one to a hidden spot.

Rotate the site each week to reduce irritation. If the rash is significant or persistent, switching to another method (pill, ring, IUD) is reasonable - mention skin irritation in a switch consultation.

The strings are very thin and most partners don't notice them. A few feel them briefly during deep penetration - this is not harmful. If the strings bother either of you, a clinician can trim them shorter at a follow-up visit.

Insertion takes a few minutes. Most patients describe a strong cramp or brief sharp pain that eases off within minutes. Taking ibuprofen 30-60 minutes before the appointment helps. Some clinics offer additional pain management (numbing gel, anaesthetic block, or oral medication) - ask in advance if pain is a concern.

Most patients can return to normal activities the same day. Mild cramping and spotting for a few days to a couple of weeks is common. Take ibuprofen or your usual pain reliever as needed. Avoid using tampons or having vaginal sex for the first 48 hours if the clinic recommends it (depends on local practice).

The hormonal IUD is fully effective right away if inserted in the first 7 days of your cycle. If inserted later in the cycle, use backup contraception for 7 days. The copper IUD is effective immediately, no matter when in the cycle it's placed.

Yes. Modern IUDs are appropriate for patients who haven't had children. Older recommendations against this are no longer in guidelines.

Rarely. About 1 in 20 patients have an expulsion over the full lifespan, with most happening in the first few months. You can check periodically by feeling for the strings just inside the vagina. If you can't feel them, or you feel the hard plastic of the IUD itself, see a clinician.

This is usually harmless - the strings can curl up around the cervix and be hard to find. See a clinician for a quick check. They can usually find the strings with a speculum exam. If the IUD has moved or expelled, a new one can be placed.

Periods usually become much lighter or stop entirely over the first 6-12 months. About 1 in 5 patients have no periods by 1 year. This is not harmful and doesn't mean blood is "building up" - the lining just isn't building up to shed.

No - the hormonal IUD is considered weight-neutral. The hormone released is local to the uterus with minimal whole-body absorption.

Rarely. Whole-body hormone effects from the hormonal IUD are uncommon because the dose absorbed into the bloodstream is small. Some patients do report mood changes, breast tenderness, or libido changes in the first 3-6 months - these usually settle, but a clinician can switch you to another method if they persist.

The hormonal IUD can cause small functional ovarian cysts that usually go away on their own without symptoms or treatment. The copper IUD doesn't cause cysts.

Very rare (about 1-2 in 1000 insertions). Perforation usually happens at the time of insertion. If you have sudden severe pelvic pain, fever, abnormal discharge, or pain during sex after the IUD is placed, see a clinician.

No - this is a misconception from earlier IUD designs from the 1970s. Modern IUDs do not significantly raise PID risk in patients without an active STI at the time of insertion.

Pregnancy is very rare (<1%). If it happens, see a clinician promptly. The IUD should usually be removed because leaving it in raises miscarriage and infection risk. Pregnancies with an IUD in place have a higher chance of being ectopic (in the tubes), which is a medical emergency.

Yes to both. With a menstrual cup, release the suction before removing it so you don't accidentally pull on the IUD strings.

Yes. Modern hormonal and copper IUDs are MRI-safe.

No. Fertility returns to your age-appropriate baseline immediately after removal.

No - condoms or regular STI testing through TeleTest is still recommended with new partners.

Same as the hormonal IUD - usually not noticed. Can be trimmed if needed.

Most patients have heavier and crampier periods. For most this stabilizes within 3-6 months. If your periods are already heavy or painful, the copper IUD is usually not the best choice.

If your periods are noticeably heavier and you feel tired, lightheaded, or short of breath, a clinician can check your iron and hemoglobin levels with a blood test. Iron supplements help most patients who develop low iron from heavier periods. If iron deficiency is significant or doesn't resolve, switching to a different method may be considered.

A very small amount of copper is released into the uterus only. This is one of the most-studied contraceptive methods with decades of safety data - no harmful whole-body effects have been shown.

Copper allergy is extremely rare. The amount released is tiny. If you have a documented copper allergy (e.g., from copper jewellery causing skin reactions), discuss with your clinician before insertion.

Yes - it is the most effective form of emergency contraception. As a simple rule, it should be inserted within 5 days of unprotected sex. In some situations, a clinician may still consider it slightly later based on the estimated timing of ovulation, but patients should seek care as soon as possible rather than waiting.

Once inserted, it also provides ongoing contraception for years.

No. The copper IUD does not change your hormones or stop you from ovulating - you still have normal monthly cycles. It prevents pregnancy by changing the environment in the uterus to stop fertilization and implantation.

No. Fertility returns immediately after removal.

Yes. The copper is not magnetic.

No. The copper IUD contains no hormones and is weight-neutral.

No. Because it contains no hormones, it doesn't affect mood, libido, breast tenderness, or any other systemic hormone effects.

It's a small rod about the size of a matchstick. You can usually feel it but it's not visible unless your arm is very thin. Most patients say nobody notices it.

It sits on the inside of your upper arm. A partner won't bump into it during normal activity. You can feel the spot if you press on it, but it doesn't move around or hurt.

A clinician numbs the skin first with a local freezing injection, then inserts the implant with a small device. Most patients describe pressure rather than pain. The site may be sore or bruised for a few days.

A clinician makes a tiny cut at one end under local freezing and lifts the implant out. Removal takes about 5 minutes.

The implant can be removed at any time. Fertility returns within 1-3 months of removal.

Bleeding patterns vary widely. About one-third of patients have no periods, one-third have light irregular bleeding, and one-third have unpredictable bleeding/spotting (some heavier, some lighter). The pattern in the first 3 months usually predicts what you'll have long-term. If irregular bleeding bothers you, talk to a clinician - options include adding a short course of pill therapy or removing the implant.

Extremely rare. If you can't feel it where it was placed, see the clinician who inserted it.

No. The implant contains no metal.

Yes, but tell the tattoo artist where it is so they avoid the spot directly over it.

Most studies show the implant is weight-neutral, though a small number of patients report modest weight gain. The change is generally less than with the birth control shot.

No - unlike the birth control shot, the implant has not been shown to affect bone density.

No.

It's given as a small intramuscular injection (usually in the upper arm or buttock) by a nurse, clinician, or pharmacist. Many pharmacies in Canada now offer injection services, which is often the most convenient option. You return every 11-13 weeks for the next dose.

Most patients describe it as a small pinch, similar to a vaccine. Mild soreness at the injection site for a day or two is normal.

In most routine Canadian pharmacy/clinic workflows, the birth control shot is given by a nurse, clinician, or pharmacist. Some jurisdictions and product formulations may allow self-injection with proper training, but this is not the default for most patients. Ask your pharmacist or clinician what is available for your specific prescription.

The shot lasts about 13 weeks, with a small safety margin. If you're up to 2 weeks late (within 15 weeks total), you can get the next dose without backup contraception. If you're more than 2 weeks late, get the shot as soon as possible and use backup contraception for 7 days. A pregnancy test before the shot is reasonable if there's any chance of pregnancy.

A modest amount of weight gain (often a few kilograms over the first year) is seen in some patients on the shot. This is the one method consistently linked to weight gain. If weight is a concern, other methods are usually better choices.

Long-term use (more than 2 years) is linked to a small reduction in bone density that usually recovers after stopping. Talk to your clinician if you have other risk factors for low bone density (low body weight, family history of osteoporosis, smoker).

Some patients report mood changes or worsening of depression on the shot. If you have a history of depression or are worried about mood effects, discuss this in your consultation. The shot is harder to "undo" quickly than a pill if mood worsens, because the effect lasts for several months.

Yes - just don't return for the next injection. The hormone effect can last several months after the last dose, so fertility may not return quickly (up to 12 months).

No.

Yes - it's progesterone-only and doesn't affect milk supply.

In a small number of patients, the shot can slightly raise blood sugar. If you have diabetes or prediabetes, talk to your clinician about whether the shot is the best choice for you.

Most partners do not notice it. A small number can feel it briefly during deep penetration - this is not harmful. You can also remove the ring for up to 3 hours during sex and re-insert it without losing protection.

Yes - it's designed to stay in. Most patients find it stays out of the way.

If it's out for less than 3 hours, rinse it with lukewarm water and re-insert. Protection is maintained. If it's out for more than 3 hours, re-insert it but use backup contraception for 7 days.

No. Anatomy doesn't allow it - the vagina ends at the cervix, so the ring can't travel beyond. If you can't find it on your own, a clinician can remove it quickly.

Squeeze the ring between your thumb and index finger so it forms a narrow oval, then push it gently into the vagina until it feels comfortable. Exact placement isn't critical - the ring works wherever it settles.

Tampons are fine. With a menstrual cup, take care when removing the cup so you don't accidentally pull the ring out.

Water-based lubricants are fine. Silicone-based lubricants and spermicides have not been shown to affect ring effectiveness, but oil-based lubricants can degrade some rings - avoid them.

No. The ring works wherever it settles inside the vagina - sex is not required to use it.

The ring does not raise the risk of yeast infections or bacterial vaginosis for most patients. A small number notice mild increased discharge, which is normal. If you develop itching, burning, or unusual discharge, see a clinician - this is more often coincidental than caused by the ring.

Once dispensed, the ring can be stored at room temperature for up to 4 months. Unopened rings are refrigerated by the pharmacy. Follow the storage instructions that come with your prescription.

Yes. The ring contains no metal.

The ring works regardless of your uterine position. Anatomy doesn't affect how the ring functions.

No.

• Vasectomy (male sterilization) - minor outpatient surgery; highly effective; sometimes reversible but should be considered permanent.
• Tubal ligation ("getting tubes tied") - surgery performed by an OBGYN; typically permanent.

Appropriate for people who are certain they don't want future biological children. Discuss with your family doctor or a specialist clinic.

Reversal is sometimes possible (more often for vasectomy than tubal ligation), but it's complex, costly, and not guaranteed. Be confident you don't want future biological children before going ahead.

No. Vasectomy blocks sperm from joining the ejaculate but does not change hormones, sex drive, erection function, or the look or amount of ejaculate.

Most clinics use local freezing. Patients describe pressure or tugging during the procedure rather than sharp pain. Mild soreness and bruising for a few days afterwards is typical.

It takes about 3 months and a follow-up semen analysis to confirm no sperm remain. Use backup contraception until that's confirmed.

Usually no. The tubes are blocked but the ovaries and uterus are left intact, so cycles continue as before and menopause happens at the usual age.

Yes. If you know you don't want future biological children, tubal ligation at the time of a planned C-section is a common, efficient option - it's done through the same incision.

Salpingectomy (removing the fallopian tubes rather than tying them) is increasingly preferred over older tubal ligation techniques. It's equally effective, has similar recovery, and may lower the risk of certain ovarian cancers later in life. Discuss this option with your OBGYN.

Vasectomy: a few days to a week for most patients. Tubal ligation or salpingectomy: 1-2 weeks. Most patients are back to desk work within a few days and can resume exercise after 1-2 weeks.

Vasectomy is generally simpler, safer, and faster to recover from than tubal ligation - if both partners are open to it, vasectomy is usually the preferred choice.

No. Neither vasectomy nor tubal ligation affects nerves involved in arousal, orgasm, or sensation.

Vasectomy and tubal ligation/salpingectomy are typically covered by provincial health plans, but specifics vary. Check with the clinic before booking.

Why the wait for estrogen-containing methods after delivery? Pregnancy and the first weeks after delivery raise your blood-clot risk on their own. Adding estrogen too early stacks the risk. Once you're 6 weeks out (and breastfeeding is established if relevant), combined methods are usually safe.

When can pregnancy actually happen again? Ovulation can resume as early as 3 weeks postpartum in patients who are not breastfeeding, and is harder to predict in those who are. Don't rely on breastfeeding alone for contraception - it's only reliably contraceptive in the first 6 months and only if you're exclusively breastfeeding day and night, and have no periods yet.

After a miscarriage or abortion (medical or surgical), most birth control methods can be started immediately unless there is a method-specific reason to wait or a usual contraindication.

Why start so soon? Ovulation can return quickly after miscarriage or abortion, sometimes within 2 weeks. Starting contraception right away helps prevent an unintended pregnancy during that window.

Backup contraception? If you start the combined pill, patch, ring, progesterone-only pill, implant, or shot within the first 5 days after miscarriage or abortion, backup contraception is usually not needed. If you start later, use backup contraception for 7 days. A copper IUD works immediately.

• Estrogen-containing methods (combined pill, patch, ring) are generally avoided in the first 6 weeks of breastfeeding because estrogen can reduce milk supply, particularly before breastfeeding is well-established. After 6 weeks and once breastfeeding is established, combined methods can be used if needed - but a progesterone-only method is often still the preferred choice.
• All progesterone-only methods are safe with breastfeeding from immediately after delivery and do not affect milk supply: progesterone-only pill, hormonal IUD, copper IUD (no hormones at all), arm implant, and the birth control shot.
• Lactational amenorrhea (no periods due to exclusive breastfeeding) is only reliably contraceptive in the first 6 months postpartum, and only if all three are true: you are exclusively breastfeeding day and night, no periods have returned, and the baby is under 6 months old. As soon as any of these change, fertility can return - so don't rely on breastfeeding alone for long-term contraception.

• Menstrual pain and heavy bleeding - combined hormonal pills can be used to reduce period cramps and flow. In conditions like endometriosis or chronic pelvic pain, combined pills can be used continuously (skipping the hormone-free week) to prevent monthly bleeding altogether.
• Acne and unwanted hair growth - combined pills can reduce the male-hormone effects responsible for acne and facial hair growth. Particularly useful in conditions like polycystic ovary syndrome (PCOS).
• Cycle regulation - for patients with irregular cycles.

Most birth control pills contain two hormones - a synthetic estrogen and a synthetic progestin (a progesterone-like hormone). These are called combined pills.

A separate category of pills contains progestin only (no estrogen). There are two sub-types:

• Older progesterone-only pill - strict 3-hour daily window.
• Newer progesterone-only pill (a different progestin class) - more forgiving 24-hour window.

• Lighter, more regular, less painful periods.
• Improvement in acne and reduction in unwanted hair growth.
• Reduced lifetime risk of endometrial, ovarian, and colorectal cancers.
• Reduced formation of new ovarian cysts.
• Help with symptoms of premenstrual dysphoric disorder.
• Help with endometriosis pain when used continuously.

The estrogen in combined pills carries some risks - though for healthy users without specific medical conditions, combined pills are generally very safe.

Blood clots (the main risk):

• Combined pills increase the relative risk of blood clots compared with not using hormonal contraception. The absolute risk remains low in healthy patients, but risk is higher in the first year of use and in patients with additional risk factors such as smoking, obesity, thrombophilia, older age, postpartum status, or prior clot history.
• In absolute terms, this is about 3-15 women per 10,000 developing a clot in the first year on combined pills.
• For comparison, pregnancy itself carries a higher blood-clot risk (about 4-5 times the baseline rate).

Other risks and side effects:

• Mild nausea, bloating, headaches, and breast tenderness, especially in the first few months.
• A small temporary increase in cervical-cancer risk (declines after stopping).
• In rare cases, mood changes or worsening of mood disorders.

Cardiovascular and clotting:

• History of blood clots in the legs, lungs, or brain (DVT, pulmonary embolism, stroke).
• A blood-clotting disorder (e.g., Factor V Leiden, antithrombin/protein C/protein S deficiency, prothrombin mutation).
• Heart disease, prior heart attack, coronary stenting or bypass surgery.
• Heart valve disease with complications.
• Cardiomyopathy.
• Uncontrolled high blood pressure.
• Multiple cardiovascular risk factors (e.g., high cholesterol, smoking, older age).

Migraine:

• Migraines with aura (see Migraines section below).

Cancer and liver:

• Current or past breast cancer.
• Liver cancer or a specific benign liver tumour (hepatocellular adenoma).
• Liver cirrhosis.
• Active or symptomatic gallstone disease.

Pregnancy and postpartum:

• Less than 42 days postpartum.

Other:

• Smoking and over age 35.
• Diabetes for more than 20 years, or with kidney, eye, or nerve damage.
• Multiple sclerosis with reduced mobility.
• Lupus.
• Some patients after bariatric surgery (depending on the type).
• Some patients after a solid organ transplant.
• History of a superficial vein clot.
• Recent surgery requiring prolonged bed rest.
• Taking certain seizure medications, certain antiretroviral medications (some HIV drugs), or rifamycin-class antibiotics - these can reduce contraceptive effectiveness or interact with hormones. Mention all your medications in the intake.

Your clinician will review your full medical history before prescribing.

The picture is mixed but largely reassuring:

• Reduced risk: combined pill use is associated with a lower lifetime risk of ovarian, endometrial, and colorectal cancers. Protection against ovarian and endometrial cancer can persist for years after stopping.
• Breast cancer: current or recent use of combined hormonal contraception is associated with a small increase in breast-cancer risk. The absolute increase is small for most younger patients, and the excess risk declines after stopping. Combined hormonal methods are not used in patients with current breast cancer and are generally avoided in patients with past breast cancer unless specialist advice supports use.
• Cervical cancer: long-term combined pill use is associated with a small increased cervical-cancer risk while in use, which declines after stopping. Routine cervical screening remains important.

Overall, for most healthy patients, the cancer-related profile of combined pills is considered acceptable and may be net protective for several gynecologic cancers, but it is not accurate to say there is no breast-cancer effect at all.

Most healthy people can safely use hormonal birth control for many years. The decision to continue depends on age, smoking status, other medical conditions, and whether the method is still meeting your needs. Periodic check-ins with a clinician are reasonable; specific re-evaluations happen at major transitions (age 35-40, after pregnancies, with new medical diagnoses).

No. Return to your age-appropriate fertility typically happens within 1-3 months after stopping. Pregnancy rates after stopping combined pills match those of women who never used birth control.

Note that fertility declines naturally with age, especially after age 35. If you're considering pregnancy in your late 30s or later, discuss fertility planning with a clinician.

Combined pills are generally safe to continue until age 50 in non-smoking women without other risk factors. Most clinicians stop estrogen-containing methods around age 50 and switch to a progesterone-only method or hormone-free alternative if birth control is still needed.

For smokers, combined pills are generally stopped at age 35.

Two good options:

• Copper IUD - completely hormone-free. The downside is periods are usually heavier and longer.
• Hormonal IUD - even though it contains a hormone, the amount that reaches your bloodstream is very small - a tiny fraction of what's in a low-dose pill. The hormone works almost entirely locally in the uterus, so whole-body effects (mood changes, breast tenderness, libido changes, weight gain) are uncommon. Most patients who choose the hormonal IUD describe it as feeling "non-hormonal" in day-to-day life, while still giving lighter periods.

If you want to avoid hormones because of side effects with the pill or patch, the hormonal IUD is usually a much better fit than its name suggests. See Hormonal IUD above for more detail.

Most combined pills are monophasic - every hormone pill in the pack contains the same dose of estrogen and progestin. A smaller number are multiphasic, where the hormone dose changes from week to week within the pack. Both types are equally effective; monophasic pills are preferred when continuous (no-period) dosing is the goal.