Babies??? No!!
June 27, 2011 2:29 PM Subscribe
YANMD (You Are Not My Doctor) but my SO is on the pill and we're wondering if we need to supplement with other birth control methods.
We are in a situation where a surprise baby would just not work. This is due to a variety of reasons, both health and environmental.
We did ask her doctor about this, specifically if we should use a condom during her ovulation period but the doctor responded with this:
"The pills work by suppressing ovulation as long as you take them consistently so ovulation should not be a problem and you should not get pregnant while on the pills."
I guess what I'm looking for here is a little more assurance than should not. I know the typical answer is that birth control is 99% effective - but how does that number work exactly? Have sex 100 times and you'll get pregnant once? If so, that's terrifying.
If we're going to use supplemental birth control (condoms) should we use them all the time? Just during ovulation periods? Or is using condoms just a waste of money (and pleasure!), and the pill will work just fine?
She's taking a generic version of Portia, if it matters.
Thanks!
We are in a situation where a surprise baby would just not work. This is due to a variety of reasons, both health and environmental.
We did ask her doctor about this, specifically if we should use a condom during her ovulation period but the doctor responded with this:
"The pills work by suppressing ovulation as long as you take them consistently so ovulation should not be a problem and you should not get pregnant while on the pills."
I guess what I'm looking for here is a little more assurance than should not. I know the typical answer is that birth control is 99% effective - but how does that number work exactly? Have sex 100 times and you'll get pregnant once? If so, that's terrifying.
If we're going to use supplemental birth control (condoms) should we use them all the time? Just during ovulation periods? Or is using condoms just a waste of money (and pleasure!), and the pill will work just fine?
She's taking a generic version of Portia, if it matters.
Thanks!
If the pill is used correctly, you're pretty much guaranteed not to get pregnant. However, the key is pretty much. There is still a chance.
If you really want to play it safe, then also use condoms (probably all the time).
Yes, the condoms are an extra expense and, frankly, make sex a little less enjoyable (although, only a little), but if an unplanned pregnancy would destroy your life, then I'd say it's worthwhile.
posted by asnider at 2:34 PM on June 27, 2011
If you really want to play it safe, then also use condoms (probably all the time).
Yes, the condoms are an extra expense and, frankly, make sex a little less enjoyable (although, only a little), but if an unplanned pregnancy would destroy your life, then I'd say it's worthwhile.
posted by asnider at 2:34 PM on June 27, 2011
At least I understand it, it's how many women out of a hundred get pregnant after a year of use. The Straight Dope answers this as well -- http://www.straightdope.com/columns/read/477/what-does-it-mean-when-they-say-the-pill-is-99-effective
posted by superlibby at 2:35 PM on June 27, 2011
posted by superlibby at 2:35 PM on June 27, 2011
specifically if we should use a condom during her ovulation period
The reason this question doesn't make sense is that if the pill is working, there is no ovulation period, and if the pill fails, there's no reason why it would fail during the middle of the cycle or any other specific time, it's (more or less) as likely to fail at any time during the month. So if you want to use back-up birth control, there's not really an advantage to only using it during her "ovulation" period.
posted by brainmouse at 2:38 PM on June 27, 2011 [5 favorites]
The reason this question doesn't make sense is that if the pill is working, there is no ovulation period, and if the pill fails, there's no reason why it would fail during the middle of the cycle or any other specific time, it's (more or less) as likely to fail at any time during the month. So if you want to use back-up birth control, there's not really an advantage to only using it during her "ovulation" period.
posted by brainmouse at 2:38 PM on June 27, 2011 [5 favorites]
Oh, maybe the OP means to ask if they should use back-up BC during the time when she's taking the inactive pill? There should be sufficient hormone levels to prevent ovulation during that period of time, but she could consider a three-month birth control (or just skipping the inactive pills) after consulting with her doctor - as far as I've read, the inactive pills are a hold-over from a time when doctors thought that the shedding of uterine lining was medically necessary.
posted by muddgirl at 2:43 PM on June 27, 2011
posted by muddgirl at 2:43 PM on June 27, 2011
I think this differs by pill, but my doctor was clear to me about maximizing effectiveness by taking mine at as-close-to-exactly the same time a day as possible. Among other things, the routine decreases the chance that you will forget one, which of course can mess with the program.
posted by mauvest at 2:44 PM on June 27, 2011
posted by mauvest at 2:44 PM on June 27, 2011
Response by poster: Sorry, I guess I don't understand how the pill works. I know that a women's ovulation typically happens between days 12-21, so the thought was to use extra protection during that time.
posted by nokry56 at 2:44 PM on June 27, 2011
posted by nokry56 at 2:44 PM on June 27, 2011
99.7% effectiveness is with perfect use (taking it correctly and regularly every time, all the time). Actual effectiveness is rated around 92%, I think. Bad odds if you cannot become pregnant.
Whether you use a back up method is about how comfortable you are with the probabilities. And the point of the pill is to prevent ovulation—that's how it prevents pregnancy. If the user or the pill fails, it could fail any time, not just during a defined period in her cycle (technically, users of HBC don't really have a cycle). Using condoms as a back up makes sense when you've missed pills or she's on antibiotics or other scenarios that reduce the pill's effectiveness.
If you are long term monogamous partners, you might consider an IUD. It's a lot, lot, LOT cheaper in the long run than either oral BC or condoms, though there's a higher up-front cost. And it's pretty much the most effective BC you can get short of a hysterectomy, with no possibility for user error.
posted by peachfuzz at 2:48 PM on June 27, 2011
Whether you use a back up method is about how comfortable you are with the probabilities. And the point of the pill is to prevent ovulation—that's how it prevents pregnancy. If the user or the pill fails, it could fail any time, not just during a defined period in her cycle (technically, users of HBC don't really have a cycle). Using condoms as a back up makes sense when you've missed pills or she's on antibiotics or other scenarios that reduce the pill's effectiveness.
If you are long term monogamous partners, you might consider an IUD. It's a lot, lot, LOT cheaper in the long run than either oral BC or condoms, though there's a higher up-front cost. And it's pretty much the most effective BC you can get short of a hysterectomy, with no possibility for user error.
posted by peachfuzz at 2:48 PM on June 27, 2011
"I guess what I'm looking for here is a little more assurance than should not. I know the typical answer is that birth control is 99% effective - but how does that number work exactly? Have sex 100 times and you'll get pregnant once? If so, that's terrifying."
This applies to an average couple (I think they figure this at one encounter per week) over the course of a year. So if you are having sex twice a day your risks are in theory increased and if only once a month then they are decreased.
However if getting pregnant will be devastating (or even unreasonably inconvenient) then double up with a barrier and hormonal. A condom is normally the back up because of it's high effectiveness but because the high reliability of the pill you might want to consider a lower effectiveness barrier like a diaphragm or even a sponge for your secondary.
posted by Mitheral at 2:54 PM on June 27, 2011
This applies to an average couple (I think they figure this at one encounter per week) over the course of a year. So if you are having sex twice a day your risks are in theory increased and if only once a month then they are decreased.
However if getting pregnant will be devastating (or even unreasonably inconvenient) then double up with a barrier and hormonal. A condom is normally the back up because of it's high effectiveness but because the high reliability of the pill you might want to consider a lower effectiveness barrier like a diaphragm or even a sponge for your secondary.
posted by Mitheral at 2:54 PM on June 27, 2011
If you absolutely, positively, completely and utterly can NOT have a baby anywhere near the picture, then you might not want to rely solely on the pill. Freak mistakes happen, and sometimes women ovulate. Some other meds reduce the effectiveness of the pill. Using condoms (or other barrier method) some of the time won't help you out, as pointed out above, so use them all the time.
The pill provides hormones at a level to make a woman's body "think" she is pregnant, so it won't get the signal to release an egg. It also thickens cervical mucus to prevent semen from getting into the uterus. The monthly period she gets on the pill is a withdrawal bleed in response to the lack of hormones and has nothing to do with ovulation.
posted by eldiem at 3:00 PM on June 27, 2011 [1 favorite]
The pill provides hormones at a level to make a woman's body "think" she is pregnant, so it won't get the signal to release an egg. It also thickens cervical mucus to prevent semen from getting into the uterus. The monthly period she gets on the pill is a withdrawal bleed in response to the lack of hormones and has nothing to do with ovulation.
posted by eldiem at 3:00 PM on June 27, 2011 [1 favorite]
nokry56, the pill works by suppressing ovulation, among other things. If she is taking it correctly, she is not ovulating.
Here is Planned Parenthood's fact sheet on the pill.
posted by crankylex at 3:01 PM on June 27, 2011
Here is Planned Parenthood's fact sheet on the pill.
posted by crankylex at 3:01 PM on June 27, 2011
I know the typical answer is that birth control is 99% effective
... if you use it properly.
The rate goes down if you forget to take them, take them and then throw them up, take them with antibiotics, or take them at random times of day.
If that's a risk, there's also Implanon which is more set-and-forget, lasts for three years and results in no periods (fantastic!).
posted by emilyw at 3:01 PM on June 27, 2011
... if you use it properly.
The rate goes down if you forget to take them, take them and then throw them up, take them with antibiotics, or take them at random times of day.
If that's a risk, there's also Implanon which is more set-and-forget, lasts for three years and results in no periods (fantastic!).
posted by emilyw at 3:01 PM on June 27, 2011
As a backup method, withdrawal is also a valid option -- practiced perfectly (which is very, very, very difficult with withdrawal, but is a starting point), it's 96% effective, down to 73% when practiced non-perfectly, which is not at all good enough on its own, but makes a lot of difference when you're already talking about the low failure rate of the pill.
Planned parenthood's birth control method effectiveness chart
posted by brainmouse at 3:02 PM on June 27, 2011
Planned parenthood's birth control method effectiveness chart
posted by brainmouse at 3:02 PM on June 27, 2011
I know that a women's ovulation typically happens between days 12-21, so the thought was to use extra protection during that time.
When you take hormonal birth control, you don't ovulate. Ovulation isn't a time in a woman's cycle, it's a thing that either happens or doesn't happen. When a woman takes the birth control pill as prescribed, it won't happen. Thus there is no way to use condoms "during ovulation". If your girlfriend is taking the pill as directed, she won't ovulate.
I've used the pill and the nuvaring at various points in my life with no backup birth control and have never become pregnant. I expect the same is true of the vast majority of women. For what it's worth, my mom got pregnant with my youngest brother while she had an IUD. No birth control is absolutely foolproof. You sort of have to decide what that means for you on your own - this isn't really a question for a doctor.
posted by Sara C. at 3:03 PM on June 27, 2011 [3 favorites]
When you take hormonal birth control, you don't ovulate. Ovulation isn't a time in a woman's cycle, it's a thing that either happens or doesn't happen. When a woman takes the birth control pill as prescribed, it won't happen. Thus there is no way to use condoms "during ovulation". If your girlfriend is taking the pill as directed, she won't ovulate.
I've used the pill and the nuvaring at various points in my life with no backup birth control and have never become pregnant. I expect the same is true of the vast majority of women. For what it's worth, my mom got pregnant with my youngest brother while she had an IUD. No birth control is absolutely foolproof. You sort of have to decide what that means for you on your own - this isn't really a question for a doctor.
posted by Sara C. at 3:03 PM on June 27, 2011 [3 favorites]
Response by poster: Why condoms over some other barrier method?
Condoms are all I know! If there's something else others would recommend I'm all ears. (STDs are no concern in our case)
posted by nokry56 at 3:08 PM on June 27, 2011
Condoms are all I know! If there's something else others would recommend I'm all ears. (STDs are no concern in our case)
posted by nokry56 at 3:08 PM on June 27, 2011
Response by poster: Thanks everyone for your thoughts so far, it looks like we'll look into a secondary method. The sponge looks like a good alternative, but is expensive ($16 for 3)
If there's lower cost methods besides condoms anyone would recommend let me know!
posted by nokry56 at 3:16 PM on June 27, 2011
If there's lower cost methods besides condoms anyone would recommend let me know!
posted by nokry56 at 3:16 PM on June 27, 2011
Scientifically, there's no real reason to use a bak up method except when taking meds that interfere with the bc; however, things you should consider: is she good at taking the pill (I'm not) and if she got pregnant what are your positions on abortion. Even though it's unlikely that she will get pregnant if the answers to both those questions are no I would use condoms all the time, every time.
posted by boobjob at 3:19 PM on June 27, 2011
posted by boobjob at 3:19 PM on June 27, 2011
I was targeting that more toward the young rope-rider and others who suggested specifically condoms.
Personally, I hated condoms and my partner hated them, too. Planned Parenthood has a pretty good list of birth control methods. From that list you could try:
posted by muddgirl at 3:20 PM on June 27, 2011 [1 favorite]
Personally, I hated condoms and my partner hated them, too. Planned Parenthood has a pretty good list of birth control methods. From that list you could try:
* Birth Control Sponge (Today Sponge)A diaphragm or cervical cap may be cheaper in the long term than the sponge but it requires a doctor's visit for fitting. Spermicides (which are used in conjuction with many other methods) can cause irritation or allergic reaction.
* Cervical Cap (FemCap)
* Diaphragm
* Female Condom
* Outercourse
* Spermicide
* Withdrawal (Pull Out Method)
posted by muddgirl at 3:20 PM on June 27, 2011 [1 favorite]
I probably should have removed outercourse...
posted by muddgirl at 3:21 PM on June 27, 2011 [2 favorites]
posted by muddgirl at 3:21 PM on June 27, 2011 [2 favorites]
Double dutch (i.e., pill + barrier method) is safest, and condoms are probably pretty much your cheapest bet unless you'll be double-dutching for a long time. Why not visit Planned Parenthood (or one of your doctors) together and get options?
"Sorry, I guess I don't understand how the pill works. I know that a women's ovulation typically happens between days 12-21, so the thought was to use extra protection during that time."
The pill suppresses ovulation ALL THE TIME. Women only still have a "cycle" for marketing reasons, really (originally the makers of the pill thought women would be creeped out if they didn't have periods ... also there's more breakthrough bleeding for many women if you just skip all periods). If a woman misses ANY pill (or even takes it at the wrong time of day, in theory), she could ovulate THAT DAY. It's unlikely, but that's the risk. Once the egg fires out the ovary and into the tube, that's that, she's ovulated, it's floating around in there on its merry way to the exit.
You should make sure to read the entire insert that comes with your girlfriend's pill; it explains the effectiveness and proper use of that specific pill, as well as what to do if a dose is missed (doubling up is often the preferred option, and works much like Plan B), what other medications can interfere with the pill (antibiotics are a big one), what to do if she is vomiting and can't take the pill, etc. Some pills you have to be VERY DISCIPLINED about taking it the same time every day (I think the minipill is like that); others are a little more flexible. It's good information to have, and it's also kind-of interesting.
posted by Eyebrows McGee at 3:26 PM on June 27, 2011 [2 favorites]
"Sorry, I guess I don't understand how the pill works. I know that a women's ovulation typically happens between days 12-21, so the thought was to use extra protection during that time."
The pill suppresses ovulation ALL THE TIME. Women only still have a "cycle" for marketing reasons, really (originally the makers of the pill thought women would be creeped out if they didn't have periods ... also there's more breakthrough bleeding for many women if you just skip all periods). If a woman misses ANY pill (or even takes it at the wrong time of day, in theory), she could ovulate THAT DAY. It's unlikely, but that's the risk. Once the egg fires out the ovary and into the tube, that's that, she's ovulated, it's floating around in there on its merry way to the exit.
You should make sure to read the entire insert that comes with your girlfriend's pill; it explains the effectiveness and proper use of that specific pill, as well as what to do if a dose is missed (doubling up is often the preferred option, and works much like Plan B), what other medications can interfere with the pill (antibiotics are a big one), what to do if she is vomiting and can't take the pill, etc. Some pills you have to be VERY DISCIPLINED about taking it the same time every day (I think the minipill is like that); others are a little more flexible. It's good information to have, and it's also kind-of interesting.
posted by Eyebrows McGee at 3:26 PM on June 27, 2011 [2 favorites]
Another vote for considering an IUD. The Mirena is great, is more effective than the pill, and lasts 5 years. Yes, there's some upfront costs and the day of insertion kinda sucks, but over time is more cost-effective than the pill and definitely sponges.
posted by cgg at 3:43 PM on June 27, 2011
posted by cgg at 3:43 PM on June 27, 2011
If terminating a pregnancy or carrying a pregnancy to term are absolutely NOT options, then I would recommend using the pill and a condom. When I was a young teenager and up through college (I had the same boyfriend throughout this whole period of time) both options would have been devastating for both me and my boyfriend. As we got a little older, and both options seemed a little less terrifying, we used condoms less and less. As I've gotten older I have used only the pill with monogomous partners, and I have never gotten pregnant. Though, now at age 28, both the options (termination/birth) seem less terrifying to me and my partners, so we calculate the risk.
What people are trying to explain about the pill and ovulation, is that since the pill prevents ovulation (and therefore, pregnancy), any misuse or random problem of the pill means that ovulation can happen at any time. Which means that if she is going to ovulate while on the pill, it can happen at any point a pill is forgotten or is otherwise rendered ineffective, which can happen at any point in a woman's cycle, not just during the time she would otherwise ovulate if she weren't on the pill.
I suggest you and your partner go to a planned parenthood together, if you have access to one, and sit and discuss your options with a clinician there. They are very helpful and do not judge you for your questions.
posted by greta simone at 4:04 PM on June 27, 2011 [1 favorite]
What people are trying to explain about the pill and ovulation, is that since the pill prevents ovulation (and therefore, pregnancy), any misuse or random problem of the pill means that ovulation can happen at any time. Which means that if she is going to ovulate while on the pill, it can happen at any point a pill is forgotten or is otherwise rendered ineffective, which can happen at any point in a woman's cycle, not just during the time she would otherwise ovulate if she weren't on the pill.
I suggest you and your partner go to a planned parenthood together, if you have access to one, and sit and discuss your options with a clinician there. They are very helpful and do not judge you for your questions.
posted by greta simone at 4:04 PM on June 27, 2011 [1 favorite]
My partner is one of eight kids and I am one of six so we're more wary/aware than most about fertility. I am on the pill but we also use condoms with every encounter because we're really totally absolutely sure we don't want to have a baby (or have to deal with an abortion). And honestly, I really see no drawback to using pill + condom.
posted by kate blank at 4:55 PM on June 27, 2011
posted by kate blank at 4:55 PM on June 27, 2011
My suggestion? Consider the withdrawal method. It's certainly not foolproof (then again, neither are condoms), but it doesn't interfere with pleasure to the extent condoms do, and it's obviously free. Frankly, it's easy to say you're going to start using condoms, but in my experience, it's much more difficult to consistently use them, especially if they greatly hamper your sensation (as they do mine). I'd never suggest this as a primary method of birth control, but as a back up method, it's worth thinking about. Just keep in mind that no method works unless you use it. This might not work for you if you don't have good control/awareness surrounding your ejaculation.
Finally, always remember that no birth control method (barring surgical sterilization) is 100% effective. If you haven't talked to your partner about what you would do in the case of pregnancy, this birth control method discussion could be a good segue.
posted by pecanpies at 5:21 PM on June 27, 2011 [2 favorites]
Finally, always remember that no birth control method (barring surgical sterilization) is 100% effective. If you haven't talked to your partner about what you would do in the case of pregnancy, this birth control method discussion could be a good segue.
posted by pecanpies at 5:21 PM on June 27, 2011 [2 favorites]
I used depo provera for six years as I am not great at remembering a daily pill. I prefered it to Implanon because I didn't really want a rod in my arm. This may be something your girlfriend wants to know more about.
posted by Trivia Newton John at 6:07 PM on June 27, 2011
posted by Trivia Newton John at 6:07 PM on June 27, 2011
Depending on where you are, you might be able to get lots o' cheap condoms somewhere local for cheap. I know Oberlin College has a sex resource center that has a bunch of them for between 5 and 50 cents; you might have someplace local like that if cost is an issue.
posted by NoraReed at 6:15 PM on June 27, 2011
posted by NoraReed at 6:15 PM on June 27, 2011
I loved my diaphragm as a backup barrier, and I am a modern gal who has tried a number of different methods (though it is probably out if either of you are sensitive to spermicide). I would recommend it, even if many disregard it as quaint and retro.
posted by vivid postcard at 6:32 PM on June 27, 2011
posted by vivid postcard at 6:32 PM on June 27, 2011
a diaphragm with spermicidal jelly makes for an excellent back-up method for forgotten pills, etc. (It can also double as a low-volume menstrual cup). Diaphragms aren't retro - they are great, female-centred barrier birth control - put in before sex, forget til morning (or whenever 6-8 hours later is).
Most failure of oral contraceptives, particularly with low-dose pills, is due to forgetting a pill or taking one late. If the female 1/2 of your partnership is really awesome at taking pills every day at the exact same time, I think you may be fine on pills alone. Me, I'm the female half and I constantly forgot pills - so I would always go with a ring or hormonal IUD.
posted by jb at 12:05 AM on June 28, 2011
Most failure of oral contraceptives, particularly with low-dose pills, is due to forgetting a pill or taking one late. If the female 1/2 of your partnership is really awesome at taking pills every day at the exact same time, I think you may be fine on pills alone. Me, I'm the female half and I constantly forgot pills - so I would always go with a ring or hormonal IUD.
posted by jb at 12:05 AM on June 28, 2011
One more vote for an IUD (or implant, I just have experience with the IUD and it's fantastic) because they're very effective and they make user error a non-issue. If you're reeeeally nervous, you could add a condom and/or a cervical cap or diaphragm.
Or stick to oral.
posted by orangejenny at 9:34 PM on June 28, 2011
Or stick to oral.
posted by orangejenny at 9:34 PM on June 28, 2011
This thread is closed to new comments.
No. When one hundred couples use the pill perfectly for one year, one couple got pregnant.
FWIW I am comfortable not using a back-up form of birth control (except as recommended in my prescription information, such as if I miss two pills in a row). But that is a decision based on the fact that an accidental pregnancy would not be ruinous, and the fact that I am comfortable with abortion as an option.
We did ask her doctor about this, specifically if we should use a condom during her ovulation period but the doctor responded with this:
This question doesn't make sense to me. Ideally there is no "ovulation" while on birth control. How would you know if she has ovulated or not?
posted by muddgirl at 2:34 PM on June 27, 2011