As moms, most of us are familiar with some form of birth control. Whether your kiddo was planned or the result of a “happy accident,” birth control has probably played some role in your teenage or adult life – and may continue to in your future. Today we’re talking with Jennifer Gibson, affectionatly known as “Jen the Sex Lady,” about all things contraception.
Contraception – in 2022, that can mean a whole lot of things. From cycle tracking to the female condom, birth control has really evolved over the years. With all the changes being made, that means there’s a lot of new info to learn about. And that’s why we’re here!
At the UM Club, we know the value of making an educated choice, and this episode will help you to make those educated choices about your own body. We’re talking about how the different methods work, choosing what’s best for you, and busting some of the many myths around contraception. This is an incredibly helpful episode when you’re looking into family planning or just want to learn more about some of the things we’re putting in our bodies to prevent pregnancy, so give it a listen and check out all of our related posts!
Looking for access to this episode and everything else we have to offer? Join the UM Club today! We bring you new episodes every week, and topics ranging from female health to parenting tips to finances, so sign up today and start living your best mom life!
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Guest Expert
Jennifer Gibson (she/her) is a professional sexual health educator and the coordinator of community education services at Island Sexual Health Community Health Care Centre. Jennifer is often referred to as “The Sex Lady” by the people she’s lucky enough to work with. She believes that conversations about sexuality should be comfortable, fun and relevant.
In This Episode We Talk About
01:18 – Who is Jennifer?
05:43 – The basics of pregnancy.
19:37 – The different birth control options.
29:47 – IUD insertion and removal.
50:09 – Final thoughts and where to find Jennifer!
Watch the Video
Listen to the Audio
Resource Links
Join the UM Club!
UM Club Facebook page
Island Sexual Health
Sexual Health Q & A Text Line: 250-812-9374
It’s a Plan website
Read the Full Conversation
Hello and welcome to another episode inside the Unapologetic Moms Club. Today I am very excited to be chatting with Jennifer Gibson from Island Sexual Health, who’s going to share with us all about contraception. So welcome, Jennifer.
Awesome. Thanks, Jannine, I’m so happy to be here. It’s really exciting to be able to talk to all your listeners and just share like the latest and greatest info.
Absolutely. Like, as moms, we’ve kind of gone through pregnancy. And I look back to when I was first making birth control decisions. And that was like 15 years ago, a lot has changed. There’s a lot more new information, new options out for us. So I think this will be a really good refresher for our community.
Yeah, awesome. Yeah. You know, often we get our kind of first intro to it in, you know, the later kind of adolescent, later adolescent, early 20s. And then that kind of is put on pause if people are pregnant or they’re planning for families. And then all of a sudden, we’re at a place where we’re like, what did I know, what’s changed? Do I go back to what I used before? We might have different goals in why we’re using methods and what’s available. There’s so many different factors. So I’m super excited to share that with you.
Me, too. All right. Well, let’s dig into it. First, I’d love it if you could share a little bit about who you are, what you do, and why you’re so passionate about it.
Yeah, absolutely. So my name is Jennifer Gibson, most people quite honestly just call me the sex lady. They have no idea what my name is. But then they see me places and they’re like, “hey, wait, are you that like sex lady?” I’m like, “yeah, I am.” And they’re like, “oh, awesome.” And so I’m a sexual health educator, which essentially means that I’m a resource for people about sexuality. And of course, one of the facets of sexuality is the prevention of pregnancy.
I also talk lots about healthy relationships and consent, and just really looking at sexuality as a positive force in our lives. And I think that’s what makes me so passionate is that, really, sexuality is something that affects all of us. And it’s probably the most dynamic experience that we’re going to go through in our lives. Like, there’s so many different factors that are going to change our relationship with sexuality, how we experience that and how we express that. And how can we do that in a way that is the most affirming and positive for us, physically, emotionally, socially, spiritually, mentally, like all of these different things.
I’ve been working in sexual health for the past 20 years. And I use the pronouns she and her. And I work with an organization called Island Sexual Health. And one of the things that we do at Island Sexual Health of course is help people with things like contraceptive choices. And looking at what’s going to fit with their life and knowing that, when we talk about things like contraception, it’s not a one size fits all for life, right? There’s so many different factors that are going to factor into it. And we believe here, as well as I, of course, do personally and professionally, that people have the human right to make choices. But you can only do that if you’re really well educated.
Yes, I completely agree. And that’s such a core to the foundation of what we’re all about. There are so many things that go into making a decision. And everyone has such a completely different situation, lifestyle, so many different factors. And unfortunately, it can be really challenging to access information on certain topics. And so we try to really try to shed a light on all different areas of it. And sexual health is such a big one, too. It’s a conversation that so many people shy away from. I do think kind of one benefit to Roe versus Wade and everything being in the news headlines is that it has really opened up a conversation and hearing so many more stories, I think is really helpful for people.
Yeah, absolutely. And I love – my personal nature is to tend to look at the positive side of things, you know. Not to whitewash, or, you know, wash away all the negative and the realities of it. But let’s look at the positive things that have the opportunity to emerge out of something really negative, like the overturning of Roe versus Wade.
And I think, you know, one of the things in Canada that we, I think, there’s been an opportunity for people to become complacent in sort of their choices around it, and assume that this is always going to be something that’s available to them. And so although, you know, we’re talking about the United States, it’s been a really good opportunity for us to sort of look at okay, what’s happening in Canada? What is our access? What do we need to know more about and how do I, personally, make sure that I’m taking the best care of myself and helping other people do that for themselves as well.
And you’re absolutely right, that education and that autonomy is the foundation of all of this. And so, you know, bringing this conversation back into the mainstream media is a fantastic opportunity to do that, right, is to look at where we don’t want to go, and how do we help others. And education is going to be the antidote, hopefully, to getting to that place.
Absolutely. I agree. The more conversations we can have, the more we can get our message out there, the more we can kind of shift perspective, make changes, write those letters, vote, all of those sorts of things come together.
So yeah, back to our conversation here today. We’re going all about contraception but before I think we dig into preventing pregnancy, let’s do a little bit of a recap of like pregnancy, how it occurs, kind of ovulation, that window, all that sort of stuff.
Yeah, totally. Okay. So when we talk about like a person with – and I’m going to use language that is as inclusive as possible. So typically, people may have been educated to have heard the female reproductive system. So typically, we’ll say like a body with inside genitals, meaning someone with a uterus and ovaries, a vagina, vulva, body with outside genitals meaning a penis, scrotum, testicles. So just as a little kind of marker, if someone hasn’t heard that language before, because it’s, you know, it’s a fairly new approach to things.
So, in order to have a pregnancy, of course, we need two main things, and ovum cell from the ovaries and a sperm cell from the testicles. And then the third thing is we need a place for that to develop. And so pregnancy, you know, living in 2022, to put the sperm and the egg together, we have a couple of options with that, right? We can do that when bodies are put together. And we can do that with the help of reproductive technology, which is pretty awesome.
And so essentially, what we need is we need the sperm and the egg to meet and we need them to implant into the lining of the uterus. And so if that’s happening through, if we call it the body way of sort of delivery, and manifesting it, if you will, or person-vesting it. So we need ovulation to happen. And ovulation typically happens two weeks before the start of the next period, or what we would call cycle bleed. And often people have been taught that if they have a cycle, a bleed cycle that it’s going to be 28 days long. Some people, for sure, it’s 28 days long. For other people, it might be 31. For other people, it might be 40. But typically anywhere between sort of like 24 to kind of 40 is your ballpark.
And so typically two weeks before the start of the bleed, which is actually the first day of the next cycle. People often think it’s the end of their cycle, but it’s actually the beginning of their next. So two weeks before that happens is when ovulation happens. And that’s just when the follicle is mature enough. Usually it’s a single one. But sometimes people release more than one. A follicle is released. If sperm is present in the fallopian tubes at that time, and the sperm in the egg meet, they’re then going to make their way back through the fallopian tubes towards the uterus. And that takes about 6 to 10 days.
So in order for an ovum cell to be fertilized by a sperm, that has to happen within basically 12 hours after ovulation. So if the sperm and the egg meet, they’re going to travel back down through the fallopian tubes towards the uterus. And then if they implant in the uterus, that’s when a person is medically considered pregnant.
And then of course, so if we’re trying to prevent that from happening, we’re going to use something to prevent the sperm and the egg from meeting. And that’s going to depend on whether people want to use hormones to provide that prevention, if they want to use a physical barrier, if they want to use a lifestyle, or a behavior based method, or a surgical method. There’s there’s sort of, you know, the different options fit into different categories of doing that.
And then of course we know pregnancy typically is what we say 40 weeks in development, you know, from what we call conception to birth. But of course that ranges too, depending on, you know, a variety of factors for people.
So interesting hearing the full process laid out. One thing I saw recently on social media – so I love your kind of confirmation or that it’s not true, is that the sperm can live inside us for up to four days. So you mentioned that the kind of meeting together needs to happen within 12 hours of the release so the sperm can kind of like hang out and be like ready to jump on it.
Yes, exactly. And so yeah, the sperm can actually – so the sperm are viable for five days. So once they enter inside the uterus and travel to the fallopian tubes, they basically have everything they need in that seminal fluid to give them energy and protection. And so really, the whole idea is the closer, you know, the longer they’re there, and ovulation happened, the two are going to meet right? And so yeah, so for five days – so that’s where your emergency contraception comes in, right?
Because when we talk about contraception, we’re usually talking about things that we’re using ahead of time, sometimes like, you know, on an ongoing basis for, say, hormonal methods, or it might be like an interim basis for like a barrier method. But those are things we’re using ahead of time, or what we would call planned. And then we know there’s situations in which people have issues of a method not working, not using a method. And so that’s where we have the emergency contraception, which essentially is going to ideally delay ovulation. So the sperm and the egg don’t meet, and make changes so the sperm and the egg don’t meet, after sex. So you’ve got a window period after the actual event to create those changes, so the sperm and the egg don’t meet.
And that would be done either through using what we call emergency contraceptive pills that are going to delay ovulation. Or we can use either a copper or what’s called the Mirena IUD, to slow down the mobility and the motility of the sperm, so the sperm and the egg don’t meet. So ideally, an emergency contraceptive pill is going to be used within five days after sex. For progestin based method that you would get over the counter at any pharmacy, the closer to the actual event, the more effective it’s going to be. And you’re looking at the sort of upper levels of emergency contraceptive pill, about 50% effective. So the sooner a person can access that, the sooner the delay in ovulation is going to happen and the more effective it’s going to be. And that’s where it gets the sort of nickname, or kind of like everyday term, morning after pill is because, you know, the sooner we can use it, the better.
There is a new type of emergency contraceptive pill, the brand name is Ella, available in Canada, and it’s not available over the counter, you need to see a doctor for it because there are some people that it’s not going to be compatible with. For example, people who are breastfeeding, and certain people that are using certain other types of ongoing contraception. So they need to be counseled by a doctor and make sure that it’s going to be, you know, effective and appropriate for them to use. It’s got a longer window period, it’s got the five days, but it’s 64% effective throughout that duration of those five days. So it would be equally as effective if someone got it on day four as day one. Whereas your typical over the counter pill, the sooner you’re going to use it, like close to the event, the more effective it’s going to be.
So it’s always good to know when we talk about that, if you’re using over the counter, you can get it everywhere. But the timeframe for efficacy, the sooner the better. Whereas Ella you need to see a doctor but you’ve got a longer timeframe for it.
And then a copper or a Mirena IUD we can insert when within seven days after sex, and it’s going to be 99% effective. And then it can stay in for any period of time after for future use, depending on the model. So a Mirena could be up to five years, a copper depending on the model five or 10 years depending on what you’re using. And often the people I work with, they’re so, you know, they’re so brilliant. And they say like, “so like, if you use an IUD as emergency contraception, it’s legitimately a time traveler, because it can work back seven days, and it can work up in the future up to five or 10 years.” Which is kind of cool. Yeah, yeah, I know. Isn’t that cool? The challenge, of course with it is that people need to access a provider to be able to insert it, right? So you need to find a doctor or nurse practitioner in the area where people are within that seven day window period.
I’ve already learned so much.
Yeah. Yeah. So it’s good to get that emergency contraception or the way because, you know, life happens, and especially when people are parenting. I often will have, like, new parents say to me, like we weren’t planning on having sex, we were thinking kind of sex was like on the, you know, the back burner, because we have all these humans to take care of. And then pretty soon they’re like, “all of a sudden it happened and like, I wasn’t thinking about it and like now what,” and we don’t always know what’s available. And the IUDs are really kind of the newest development in emergency contraception. So it’s always good to just have that in the back of our minds. There are ways to prevent following.
Absolutely. I had only known about the morning after pill, which I personally had taken when I was 16. But I didn’t know about Ella or the IUD. So that’s really interesting. And it’s funny. The more I learn, the more it’s like, no kidding. I had a pull out baby. Because I was like, I’ll track my cycle, I only use this app, I know when I’m ovulating and that’s when I have to be careful. I had no idea that ovulation is tied to the bleed and not the start or that an app doesn’t necessarily know me.
Well, and I love that Jannine. I love that. I love that you brought this up, because there’s been a real rise in popularity. I mean, well, technology is life right now. Right? And so with people using apps to track their cycles, which I think can be such a good self-awareness piece, but it’s based on an algorithm, and bodies have their own algorithm that isn’t necessarily technologically based. And so things like stress, things like change in diet, change in exercise, travel, other medical issues, medications, can affect our ovulatory cycles.
And so knowing that if people are using apps to track cycles, just think about that as a piece of information, right? Like, it’s another piece, it’s another tool. But if people are really wanting to prevent a pregnancy, like that’s not in their game plan at this time, either they feel like their family is complete or they want a big space between pregnancies or like, you know, there’s people who might be parenting who haven’t had a pregnancy and don’t ever want a pregnancy, right? So if they absolutely don’t want a pregnancy, it doesn’t fit in their gameplan. What we would say is use that as a piece of information, but think about how effective methods are going to be.
And we know if we look in, you know, we look in textbooks, they’ll say the withdrawal method or you know, the science term is coitus interruptus – I love it. “We practice coitus interruptus.” The students love that in school when I talk to them. I’m like, yeah, here’s fancy medical terms for you. And then, of course, the pull out method’s often been called, like, the pull and pray method or, you know, whatever, the pull out game, that’s what often people will say to me.
And then if it goes wrong, it doesn’t feel so much like a game, right? But it, you know, if you look at it, they say, in the, like, 70s and 80s, like in percentage wise. And I would say anecdotally, like, it’s much lower than that, just knowing and working in this field for so long. So, yeah, like, think about, partnering that app with another method. But if we’re really in that place of wanting to prevent, we want to start with the things that are the most effective, and also the easiest to use.
Because when people are parenting, you know, your lifestyle has completely changed. And so something that worked for someone at 16, it may not be as effective to take a pill at the same time every day, at 26 or 36. You might need something that gives you more flexibility, whether you’re doing it weekly, monthly, every three months, every five years, you know, there’s so many different factors that I think people, you know, need to consider. Cost is another thing, right?
Even time management, you know, returning to a doctor to get another prescription. It can seem like it’s a really easy thing to do. But like, we know what the wait times are like trying to get into a walk-in clinic, if you’re not lucky enough to have a family physician. I mean, there’s so many barriers to this. So I really think that, you know, when we’re talking about something as important as control over our reproductive lives and choices, that the knowledge and the assessment of like, what is going to work for me, right? How is this going to work for me?
And I think a lot of times we’re put – and especially, you know, female identified, folks. I mean, there’s so many responsibilities on us already, but like this idea about how are you gonna use this well, but how can I work with it for it to work the best for me. And there’s nothing wrong with saying, you know what, I’m touching my toothbrush to see if I brushed my teeth, right? Taking something at the same time every day, it’s just not gonna work for me right now. And you know, I need something that gives me some more flexibility.
Absolutely. So let’s dig into the birth control options, and I’d love to hear about both hormonal and lifestyle and surgical as well.
Yeah, okay, cool. So one of the things that when we talk about, like, kind of just assessing what’s out there, the really good question to start with is where does the pregnancy fit in my life plan right now? And so if a person is like, “yeah, it doesn’t fit in my life plan right now,” then what we want to do is we want to look at the most effective, and what we know right now, other than abstinence, of course, right, which is always a choice for people. But not always the most desirable or realistic, let’s be honest. So we’ve got abstinence at 100%. But then we want to go, we will work our way down from that.
And so in our 99% effectiveness, that’s where we find the long-acting reversible contraception or what they call LARCs. And of course, your IUDs are going to fit into that. So that is your implant. And of course IUDs, we have hormonal and nonhormonal.
The implant in the arm is hormonal. It goes in the upper arm. So like right here, yeah, it goes right here. And it actually, if you have a look at it, I actually have like kind of a model, if you can see it there, I don’t know if you can see it. I’ll put it against my hand and then hold it. Under here, you can sort of see. So it’s not very long, it’s about like, four centimeters long, like a millimeter sort of in diameter, it’s flexible. So it will move as the arm moves. And it can be used for up to three years. So it’s 99% effective, it can be used for up to three years. It’s a progestin based hormone. So if people can’t use estrogen for, you know, a variety of reasons, whether it’s migraine with aura, whether it’s, you know, mood, I mean, there’s different reasons people wouldn’t want to
Is this with breastfeeding too? I remember you have to take a mini pill because one of the hormones isn’t good for breastfeeding. So that could potentially be a breastfeeding option?
Yeah, we absolutely can use that for breast or chest feeding. We can put one in basically two weeks postpartum, which is great. Yeah. And so we make a tiny incision, with local freezing, tiny incision, slide it in, and then it is going to be palpable. Like you’ll be able to feel it underneath the skin, which some people really like the idea of because then they’re like, it’s here. Yeah, like it’s here, right? Whereas with an IUD, sometimes people, if they’re not doing string checks, for example, or a partner is not, they’re kind of like “is it there?”
So this is palpable, can stay in for three years. And essentially, it’s just sending the progestin through the bloodstream, into the bloodstream. And then to remove it, we make an incision and take it out, and a person can have another one put in, usually we put it in the non dominant arm. Yeah. So it’s called Nexplanon. It’s been in Canada since May 2020. But if you look to other parts of the world, it’s been used for well over, probably close to a decade and a half.
The reason we’re kind of slower to catch up in Canada was because when it was presented to Health Canada for approval, they felt that the research wasn’t done, it wasn’t current enough. So they asked for newer research on it before they would provide approval, which is great. Health Canada is quite conservative in their approach, which is always a good thing, I think, right? It helps to protect us.
Yeah, and the price range is about, you know, around that kind of IUD price range like 350 to 400, and it gives the three year continuous coverage, it can be taken out at any point. And because it fits into that long-acting reversible, if people, you know, made a different decision in terms of like yeah, actually we want another pregnancy, I want another pregnancy, it can be reversed and it can be taken out and the return to ovulation is very quick.
So it prevents ovulation, thins the lining of the uterus, and builds up cervical fluid. So it’s got that kind of triad approach. Side effects, you know, because it’s a progestin based, similar to Mirena or Kylena IUD, you’re gonna see a change in bleeding patterns. So usually less bleeding over the duration of the time, but in the interim, it might cause atypical bleeding, which could be anything from no bleeding, to a bit of spotting, to more frequent bleeding, we usually say like black underwear and liners kind of keeps you through that transitionary period. Some people, like again, it might be headache, it might be chest tissue or breast tenderness. Your more common side effects.
But when we say that, again, when we talk about side effects, they should be about like if people experienced them about three months, kind of, during that timeframe and then people see those usually decrease. But I think a really important point is that people are their own experts on their own experience, in their own body, and they live in them 24/7. And so if they notice something that they can tie back to beginning any kind of medication, and they go, “this is something that’s like taking away from my life, it’s not adding to my life,” those are times to go back to health care providers and talk really honestly about it.
Because, you know, I think often people go, like, “I think this is going on, but you know, I like, I haven’t heard other people talk about it. I don’t think that, you know, I don’t think it’s like realistic or it’s like, you know, justifiable.” And I would say anytime something’s going on for someone, if they’re noticing it, they’re spending time thinking about it, it’s taking away from their life, that’s time to go back and go, “hey, I’m noticing this, is this typical? Should it subside? Is this working for me?” Because if you’re spending time thinking about it, and it’s creating a less than ideal situation for someone, then maybe that’s not the method for them. You know, it’s something to consider.
So, okay, so we’ve kind of jumped around. So we so that that was the implant, the other ones that fit, of course, in the long acting reversible contraception would be your IUDs. And they fall into two categories. They fit into the copper, which is non-hormonal, looks like that, has some copper wound around the base, some will also additionally have it at the top. And its main mechanism of working – it doesn’t affect ovulation – is that it changes the environment in the uterus. So it slows down the sperm, and it prevents them from causing like fertilization essentially.
Your main side effect with a copper IUD is going to be an increase in cramping and bleeding for people during their bleed cycles. And so for someone who had a painful, heavy period, strong cramping, that may not be their first choice, because we do know that it’s more likely to increase that for most users. But there’s no hormones in it. It’s immediately reversible when we take it out. Ovulation hasn’t been affected at all, so that ovulatory cycle. Yes. Yeah. Which is great. And it’s affordable, it’s usually about $100. And if people can use that between 5 to 10 years, you know, $100 might be a big outlay of money initially, but over five to 10 years, you’re looking at 10 to $20 a year, which is great. Yeah, and many people like the idea that, you know, it isn’t affecting their hormonal cycle. So that’s the copper IUD.
And then of course, the other two contain a progestin hormone. So we’ve got the Mirena and the Kyleena, and they use the same hormone, they just draw in different amounts. So the Mirena has more in it than the Kyleena, they’re slightly different sizes. The Kyleena is a little bit smaller than the Mirena, if you can see it. They’re going to, again, thicken the cervical mucus and then thin the lining of the uterus, most people will continue to ovulate using them. So its main mechanism is that barrier, and then the thinning of the lining of the uterus. And the most common side effect is the change in bleeding cycle for people. And it may cause it to be more frequent, and then it’s going to become less frequent.
Mirena has actually been used for people who have heavier bleeding, or other heavier cramping, they’ll often use it for that as well. So these actually offer bleed control and birth control for people. This one is going to be sort of more effective about 90% less overall blood loss, and about one in five, 20%, lose a bleed altogether using it. So some people are going to use it for that. Some people use it for both, right, which is great. And their price points again, depending on where people get them, their prescription is base like the copper, about $350 to $500. It just depends on the pharmacy.
So again, a big outlay of money, but a five year duration for people, if they want to use them up to that point. But of course, we can take these out at any point too, and they’re reversible. So people will return to their cycle of fertility when they’re removed. So it’s not going to cause long term issues with fertility. In fact, no birth control methods have an effect on future fertility. And that’s a really big one that people often have been told, especially earlier in life. If they started methods, it would decrease their fertility later in life. No, absolutely not. Our biggest connection to challenges with fertility are untreated sexually transmitted infections and age, right?
And there’s going to be a certain percentage of people who have lower fertility and you’re not going to know that until later on when you’re trying. It is interesting to learn about this and that you do still ovulate, so you are still having your natural rhythms but it’s inhabitable, to prevent pregnancy. So what do insertion and removal look like for this?
Yeah, yeah. So even though the three or, you know, different, insertion is going to take usually less than five minutes. There’s going to be cramping. And when we talk about cramping, it’s like, we could line 12 people up who had an IUD insertion, and you would have 12 different experiences, ranging from like, “I didn’t really notice” to “that was pretty intense.”
And so typically, what we get people to do, we, you know, we educate them ahead of time. So if they can, they take ibuprofen ahead of time, they have, you know, a meal to keep their blood sugar steady before they come in, they have someone to accompany them if they can on the way home and just in case they’re not feeling great. We don’t want them to be driving or on their own getting home. Most people tolerate it incredibly well.
And what I would say is, if people are thinking about like an implant or an insertion, like anything that involves something being put in our body, we want the provider to be doing this really regularly. So a really good question is, like, how many insertions have you done, how comfortable with the insertion are you? Because if the provider is really comfortable, that’s going to increase your comfort, and it’s going to make sure that the experience is better for you. And it’s also going to relieve any anxiety that people might have.
So insertion takes less than five minutes, you know, experience some cramping, most of that cramping settles within a short period of time, some people will continue to cramp kind of like throughout, for the next day or so. So ibuprofen can help with that, you know, magic bag, maybe having a time where you’re maybe not having to do as much. And I know if you’re parenting, like really, is that ever, you know? So that’s something I say ironically.
And then removal, again, really simple. Again, we want people to go to a trained inserter to remove them, but they take like seconds to remove. And but again, when people stop a method, the protection stops, too. So sometimes people think if they, you know, stop a contraceptive method for whatever reason, well, they’ve probably got a little bit of kind of like, you know, crossover time, and bodies are really interesting. They sometimes are like, “oh, hey, we don’t necessarily have crossover time.” So when people stop methods, their protection against pregnancy also stops, which that’s, you know, that’s the beauty of these things being reversible and giving us that flexibility for people as well.
So those are the three that fit into what we would call long acting reversible contraception, they can all be used during breastfeeding. If we don’t do it immediately following birth, like in the delivery room for example, we’re going to do it six weeks postpartum, just because the uterus of course is returning to near its natural size. And that can increase risk of it leaving the body if we put it in too soon afterwards. And then, so we’ll work our way through if we talk about other hormonal methods.
The depo injection, which people often know, we can use that as soon as two weeks post postpartum for folks. They can use it while they’re chest or breastfeeding. Again, 99% effective, so we’re talking that really high. So when I give you a percentage, I’m saying like 99% effective. What that means is like 1 out of 100 have an unintentional pregnancy over the course of the year, right? And having sex in regular intervals, 1 in 100 would have an unintentional pregnancy, using those perfectly.
The injection is given every 12 weeks. It’s given into the shoulder muscle or the hip muscle by a doctor or a nurse. And so people need a prescription for that. It’s just progestin. So it’s a high level of progestin, or a higher level, because we’re giving it for three months. So we give a single amount, and then it slowly works through the system. So it prevents ovulation. It thins the lining of the uterus, and it thickens the cervical fluid again, which acts as a barrier. Most people, side effects they’re going to see things like a change in bleeding patterns. Again, some people it will become heavier, some people it’ll become more random. Some people won’t have bleeding at all.
The common side effects, again, with this, we can see mood changes, chest and breast tenderness, headache. This is the only one scientifically that’s been connected to weight gain, because that’s a big question that I get from folks. And that’s completely, you know, a legitimate question. So what they say with this is if people experience weight gain in the beginning, often that weight gain may continue. And it’s not connected to like metabolism, it’s connected to increased appetite. So for some people, this hormone in this amount increases appetite. And so if we’re taking in more fuel than we’re expending, that leads, of course, to weight gain. So that is something you know, just to be aware of.
And that would be, like when I say weight gain, like about five to 10 pounds in a year. But again, not everyone experiences this. So when we talk about side effects, it’s not a guarantee. But there are things to think about, and how comfortable are we with those things? And if someone goes, no, like, you know, physically and emotionally, I can’t deal with weight gain, then that might be a reason people go this isn’t for me. So I think we always need to think about what it adds to my life, what it potentially could challenge me with, right, and go where we feel most comfortable.
The price point is anywhere between about $35 to $60 per injection, and people are going to need four to five during the year. So it’s fairly cost effective. Of course, once we put it in, we can’t take it out. So it’s going to give that protection. So if people had it and they go, “I don’t like these side effects,” we have to wait for it to work through. And it does, it’s reversibility – what we say is the return to ovulatory cycles can take about 8 to 10 weeks after the last injection. So if people are thinking about it as kind of a holdover between pregnancies, or a spacer, it may be a longer space than other methods. So that’s, you know, something just to keep in mind. And then of course, if people aren’t needle people, we can’t put it into the body in any other way. So that’s something to think about.
And then in terms of other hormonal methods, you’ve got the combined methods. So people are probably pretty familiar with the combined pill, with the patch, the ring, right? They all use the same hormones, but they’re put into the body differently. So this of course we swallow, goes through our digestive system. This you wear on your body, it goes through your skin. This is put into the vagina, the middle opening, and it sends the hormones through the vaginal lining into the bloodstream. So daily, weekly, monthly, in terms of how often we’re using them.
And the side effects typically are going to be quite similar. If people experience them, again, should go away within about three months. So headache, breast tenderness, chest tenderness. Change in bleeding patterns, usually makes it less because it’s thinning the lining of the uterus, preventing ovulation and thickening cervical fluid or mucus.
Usually, because of estrogen, we don’t use them for about four weeks postpartum. And we don’t use them because they can increase the risk of blood clot. And so can our postpartum period, right? So we don’t want to put those together. And usually we’re only going to use them when breast and chest feeding has been very, very well established, because they can interfere with the production of breast milk, unlike the progestin based methods. So we usually, often, you already mentioned the mini pill, we often introduce soon after birth if people are looking for a method, and then we often later on, we’ll swap them over to a combined method.
Because of course, the difference with the mini pill and the regular pill is the mini pill only uses progestin. And so it’s thickening the cervical fluid and thinning the lining of the uterus. But ovulation can still happen. And so people need to be very, very vigilant in taking a mini pill, they have to take it within a 3 hour window period of the time they took it the day before. And I mean, you know, as a parent, like it’s really difficult. The best of plans, and still, your tiny humans have really big ideas of when they need things?
And so what we say to people, if people are doing the mini pill or progestin only pill, multiple alarms and always having more than one package on hand. One in the diaper bag, one in a wallet. Because you always have one or the other, right, which is great. Yeah, so that’s the big thing. Whereas a combined method, you’ve got a bit more flexibility and timeframe because its main mechanism is preventing ovulation, whereas the mini pill it’s not. But we can start that when people are breastfeeding.
So yeah, these are all things that we want to keep in mind. People ask me about breastfeeding as a birth control method lots, and great built in backup method, but as a primary method, no. So primarily if people are exclusively breastfeeding, that should suppress ovulation because your body is producing prolactin, which should suppress ovulation. But exclusively breastfeeding means every four hours during the day, every six hours at night, no other fluids or energy sources for the baby. No bleeding has returned.
So they say for the first six months, like “oh, 99% effective.” I can tell you after 20 years in working in this area, I have numerous times worked with people who are like, “yeah, there were no spaces. I don’t know what happened.” The body can ovulate, which seems kind of bizarre, as early as three weeks postpartum. Right? Like, you’ve just birthed this person, you’re just used to like having this person on the outside of your body, you know, if you birthed it, or in your home if you’ve adopted. And you’re like, “what,” like what’s actually happening here, right?
So yeah, it’s a great free backup method. But if we don’t want to achieve pregnancy, we want to use a primary method. And so often what people will do is like, go back to the barrier methods in the interim. So again, a condom, right? Because they’re easy to get, you can get them free from many health centers. They have a shelf life of three to five years.
But it’s funny, I just worked with a parent the other day, who said to me, you know, “when I went in to buy condoms again, I felt kind of embarrassed. Like, it took me back to being in high school and buying condoms,” which I thought like, what? When are we as a society going to break through the stigma and just be like, you know what, when people are buying condoms it’s just them being healthy and responsible, like, great. It doesn’t signify anything else. It’s so interesting, the stuff we carry with us. And you know, that’s why this podcast is so great, because we can break down the stigma and the shame and just be like, “yeah, great, like, let’s have these things available.”
So of course, we’ve got that outside condom, which many people are familiar with, goes outside, we use it immediately, you know, before sex happens, covers the outside genitals or the penis, perfect use 98% effective, average use about 85% effective. Because sometimes people have a little bit of sex and then put one on. Not always the best plan, because we know sometimes pre ejaculate can contain sperm. And we know sometimes things happen before people actually plan for them to happen.
And then, of course, we’ve got the inside condom. So people aren’t always familiar with this one, and this one can be a really good one, especially postpartum, when the lining of the vagina is thinner. And sometimes sex, you know, isn’t as comfortable because bodies aren’t lubricating enough, or if people have had stitches. Even with kind of the least challenging of births, we know the lining of the vagina is thinner because of a drop in estrogen, lack of lubrication. So, you know, there’s so many different factors there.
And so the internal condom goes inside the vagina, and you can put it in up to six hours ahead of time. So if you know tonight is date night, and you don’t want to be like “hold that thought, wait until I just go and do this.” And then the thoughts gone because the baby’s crying, or, you know, your child wants to co-sleep, you know, whatever, the hydro bills do, and you’ve got 10 minutes to pay it online. Like, you know, life, right? You can put this in up to six hours ahead of time.
And so squeeze the top together, one hand is gonna go inside, slide it into the vagina, it’s gonna sit higher at the top under the cervix. And then penis goes inside here. And then after sex, it doesn’t have to be taken out immediately. Because it’s going to be held in place by the walls of the vagina. So bodies can stay together, they can enjoy some, you know, just kind of post cuddling whatever. And then remove the penis.
This we just twist like that, slide it out, wrap it in tissue, throw it out. Now, here’s the other thing. Some people say if a penis goes inside there that feels really good to the tip of the penis. And other people say this feels really good to the clitoris. So some people are using it for pleasure and protection. Imagine that, the whole thing, righ? Yeah, because that’s the other thing, is that your birth control method should be increasing your ability to experience pleasure, not decreasing it.
And so sometimes, you’re worried about how well it worked. Did I put it in right? Like all of these things can play into factor. Is the hormone changing my libido? Like all of these kinds of things. So yeah, it’s finding what’s going to work for us. So many people come in and they’re like, yeah, this actually feels really good against the clitoris. It’s also not latex, so if people have latex sensitivity.
So basically, it’s going to be really well lubricated outside and inside, which is good. But yeah, we’re gonna have to guide whatever’s going in there, right, we’re gonna need to guide whatever’s going in there. And so some people are like, that doesn’t seem super sexy. And then other people are like, well, you know what that was kind of in the beginning. And, you know, these are the things that we do to put bodies together. But we don’t talk about it, unfortunately.
But yeah. And it’s really accommodating if people are thinking that, you know, condoms fit a bit snug, or they don’t feel comfortable with them, for whatever reason. It’s very accommodating, which is great. They only come – if folks are here in Canada, it’s always in a white package. It always looks like that. In other countries, it’s gonna be the same pack size package, but different colour, either pink or purple. Yeah, instructions are on the back, too.
Sounds like it could be a really good option for postpartum people. And just easy access and good to have around.
People are like, “how do I use that again?” Yeah, and just have them around, right, to have these things. And then the other thing, you know, lubrication, we talked a little bit. Please, all bodies that are being put together – anything that’s been put into a body, below the waist. Even if we’re talking about using things like sex toys, or what we call – I like to call them actually sex tools, because they’re just tools to help us know our bodies, experience pleasure, or partner, etc. Partner or partnerless, lube is so important.
And we have this idea that all bodies are going to lubricate the exact amount, or pre-pregnancy they lubricated really well, or during pregnancy, they lubricated really well. That’s going to change during a lifestyle or doing a lifespan, right? And we know that people, if they’re breast or chest feeding, they’re usually are dehydrated. And that can also affect lubrication. So all bodies should use lubrication.
And people should try lubrication on their wrist, on themselves and their partner or partners. If there’s no reaction there, try here, in the inside of the lip here in the mouth, and then in the genitals. And sometimes people will notice they have a reaction, and they’re like, whoa, like I’m having symptoms like itchiness, redness, discharge, and they automatically go to kind of infection place. And so they should always follow up with a doctor. But sometimes it can also be sensitivity to lube, different kinds of lubricant. So that’s another thing for folks, you know, lube is your friend. It’s a really important piece of sexuality and makes for comparable sex
I love that testing piece, because I’ve never heard anyone talk about that before. I have a friend who had a reaction to it a wax, so I imagine if that was my situation, I would probably be a little bit more apprehensive of lubricants and things like that.
Yeah. Yeah, totally. And people sometimes, that’s why they’ll buy like little packages, little testers, before they buy a bigger bottle, just just to try it. And then of course, knowing different types. And if people are using sex toys or sex tools, they don’t want to use a silicone lube and a silicone tool. They don’t like each other. If they’re using latex barriers, like condoms, they don’t want to use an oil base. Like there’s so many different factors to this that we really lack the knowledge around.
And so like, you know, going into a specialty shop, buying the little ones, testing those out and then making our way up. And have a look at the ingredient list. It’s like anything that we put in our body, the more ingredients that are in there, the less friendly they usually are to the inside of our bodies. So we should always look for something, you know, water based, there’s vegan, there’s gluten free, if you can imagine, right? So important. So yeah, these are things to know for sure.
We’re unfortunately coming up to time. We can go on and on but I do have another interview coming up. So I’m thinking if you’re open to it in the future, I’m going into another more non-hormonal ones where we get around to other options as well, like the lifestyle and tubes tied and that sort of stuff.
Totally. Yeah. And we’re actually – I’ll give you a website, through the Society of Obstetricians and Gynecologists in Canada. So it’s not any kind of sponsored content. It’s called ItsAPlan.ca. And a person can go in there and ask questions about their lifestyles and their needs. And it will take all of the different options in Canada and narrow them down based on what they need. Yeah, it’s fantastic. And it goes through all of those methods as well. So before we can have a chance to chat again, if folks need information that’s non biased, I would tell them to go there.
It’s been an absolute pleasure, looking forward to having you back. Where can people go to find more about you, or Island Sexual Health, or any other resources that you would like to mention?
Absolutely. So IslandSexualHealth.org is our website. You can pop on that. People also, if they have non medical based questions, they just want some more general information. They can text us, we actually have a text line for questions. Yeah, it’s, I know, it’s super cool. It’s 250-812-9374, is the text line. And you don’t tell us anything about yourself. Like no name or anything like that, just send in a question. Like if people wanted to know, like, for example, “I’m camping in this town, and I need to get emergency contraception. Where do I go?” They can help and we can help connect them to resources that way. Yeah.
Thank you so much for having me. And yeah, I would just encourage everyone, you know what, like you are the expert on your own body and look at what you need in your lifestyle right now. Involve your partners in this decision as well, because that’s a whole nother ballgame. But yeah, so that we can all be responsible and so that this can be such a positive effort, empowering and pleasurable experience, imagine that.
I love that you’ve touched on that, and that it’s your life and the lifestyle you want and not adding on more to this mental space that as moms, we already have so much going on.
Yeah!
Thank you so much, we’ll have everything linked. And for those listening in, you can go head to our group chat or Facebook group and we can chat about it more. I’m curious what you guys are using or what kind of habits you may have. So until next time, take care!
Thanks for listening this week! If you want to chat about this episode with me and other moms, check out the exclusive UM Club Facebook page! Thanks again, and we’ll see you next week!
