27 Things About Birth Control An Actual Doctor Wants You To Know

    "Is this normal?!"

    We recently asked members of the BuzzFeed Community to tell us questions they had about birth control that they were too scared to ask.

    Then we spoke with Dr. Sophia Yen, MD, MPH, who is an Associate Professor of Pediatrics in the Division of Adolescent Medicine at Stanford Medical School and CEO and Co-Founder of Pandia Health, to get her expert responses on these questions.

    1. "Can birth control pills render women infertile in the long run?" — zahra09h

    Dr. Yen: "No. What it is, is that 10% of women have PCOS (Polycystic ovary syndrome). PCOS women will have a hard time getting pregnant. So if you put all women on birth control, and then take them off, you expect 10% of women to have a hard time getting pregnant. It is NOT because of the birth control, it’s because of the PCOS. Oddly enough, for PCOS women, sometimes being on the birth control (which normalizes their hormones) then coming off is when they are most fertile because that is when their hormones are most normal."

    2. "Can an IUD be punctured through the uterine wall if your partner/spouse has a large penis?" —loraafinley

    Dr. Yen: No. Usually it happens on insertion of the IUD by the practitioner. Or the practitioner stuck it in the wall and the uterine contractions pushed it through. But not by penis."

    3. "Is there a 'window' of time for me to take my oral birth control? I know you have to take it at the same time every day for it to be effective, but what if I miss the mark by 15 minutes? Am I still OK?" —emilys44b743fcd

    Dr. Yen: "If you are on the progesterone only pills, you have a 3 hour window. If you are 3 hours or more late, you need to use emergency contraception if you had sex within the past 5 days and use a backup method or abstain for the next 5 days (while you catch up). If you are on the 'regular' estrogen AND progesterone 'combined' pills, then there is a larger window. You can miss 1 pill and still be OK. 2 pills sometimes OK. But at 3 pills, definitely consider emergency contraception if you had sex within the past 5 days and use a backup method or abstain for the next 5 days (while you catch up)."

    4. "Can birth control cause vivid or really weird dreams?" — preistessofsass

    Dr. Yen: That is not a reported side effect, but anything is possible. Each person is different and might respond differently to the medication."

    5. "Is it possible that birth control isn’t right for me? I’m trying really hard to be safe but I’m getting so exhausted from having side effects." —jordans4bf42d485

    Dr. Yen: There is the IUD with hormone, the IUD without hormone, the implant, the shot, the vaginal ring, the patch, then there are like 40 different pills. One of these should work for you, but if not, using condoms plus spermicide is 97% effective in preventing pregnancy.

    6. "Do you need to be on birth control before you have sex for the first time or is a condom enough to prevent pregnancy?" — OliviaR821

    Dr. Yen: "It depends how bad getting pregnant would be to you. I advise everyone with a uterus who is not trying to get pregnant to use condoms PLUS a hormonal method or copper IUD to avoid pregnancy."

    7. "I take birth control pills so that I can skip my periods (which are pretty debilitating) but I’m pretty bad at taking them regularly so I always need a secondary contraceptive. Could an IUD mean that I still get no periods or at least easier ones?" —RachelDiz

    Dr. Yen: "You might want to try the IUD with hormone. 19–37% of women on the regular strength IUD with hormone lose their periods. And the rest get easier/lighter ones. You could also use the birth control ring (Nuvaring) for that. And there is a new vaginal ring Annovera which could be used for up to 1 year."

    8. "Is it normal for my acne to seem to get worse after starting the pill? (I’m taking the one with estrogen and progestin.)" —madelynf487f41e0c

    Dr. Yen: Going on the pill changes up your hormones. Sometimes it takes 1–3 months to get used to the hormones and then things to calm down. Theoretically, all birth control pills should help with acne. Sometimes it’s the hormone in the pill that you were prescribed. For acne we recommend less androgenic progestins such as norgestimate (if you are not skipping bleeds), desogestrel (if you are skipping bleeds) and drosperinone (if the other two don’t work and you can drink 8 glasses of water a day). There are also a few others you can try."

    9. "Do you have to take the inactive pills? Or can you just skip taking pills for the week when you’re supposed to take them?" —madisonpaigearthur

    Dr. Yen: You do NOT have to take the inactive pills. They are just a placeholder so you don’t get out of practice taking your pills 1 week out of 4 (25% of the time)."

    10. "Within the past few months, I've started spotting while on a certain type of pill. Why would that start happening when I never had that problem before?" — PaopuFruitNoot

    Dr. Yen: "If you have been on that pill awhile, then most likely it is because you have changed something else — for example, a supplement (which can affect absorption) or an over the counter cold medicine like pseudoephedrine or another medicine (which revs up your liver and chews through hormones more). Other things that might cause spotting are a polyp, a sexually transmitted infection causing your cervix to be friable (easy to be irritated and bleed), or weight gain/loss."

    11. "Do you ovulate while on the pill?" —sarahm46a7cbcdf

    Dr. Yen: "The pill works by preventing ovulation, thinning your endometrium, causing a cervical mucus plug (with progesterone). However, some people may ovulate on the pill, especially heavier people, because the pill was made for a “standard weight" and the dose may not be sufficient to block ovulation at days 5–7 of the pill on the placebo/sugar pill/bleeding week. At Pandia Health we recommend women either #SkipTheBleed or only be off for 5 days maximum and maybe 4 if your BMI is >26."

    12. "Do you still ovulate with an IUD?" —courtneyjok

    Dr. Yen: "With the copper IUD, yes. With the IUD with hormone, 65% of women still do. And if you are on the “lower hormone” IUD, then you're more likely to have more ovulation given the lower hormone."

    13. "Is it true that oral contraceptives can give you symptoms of depression?" —TessMess01

    Dr. Yen: "Recent studies indicate that women who do not suffer from PMDD-induced depression symptoms are at a slight increase of depression when taking certain hormonal forms of birth control. Although the risk of depression is increased for all types of hormonal birth control, the chance is incredibly small. Because studies in this arena are new and the science behind it emerging, there is no conclusive data on who is most susceptible to this increased risk yet."

    14. "I think my birth control gives me cramps outside of my period. Like, painful sharp pain in my pelvic area completely outside of my menstrual cycle — is this possible?" —rebeccan4bb72d040

    Dr. Yen: "This is most likely NOT from the birth control. It is more likely from ovulation pain, endometriosis, or something else. Birth control stabilizes and calms things down. Sharp pain is not an aspect of birth control — dull cyclical pain, possibly — but sharp recurrent pain, no."

    15. "What are the failure rates of having your tubes tied vs. a vasectomy? Which one is more painful or has longer recovery time?" —speaktruthnoharm

    Dr. Yen: "Vasectomy beats tubal ligation (i.e. getting your "tubes tied") in efficacy. It is 3x as effective as tubal ligation in typical use and is far less invasive. Getting to the fallopian tubes you go through the abdomen (which has many layers of muscle) and is much more invasive. Also, with tubal ligation, there are far more risks, it's far more costly, and the side effects are far more serious."

    16. "Can birth control help with regulating hormones from a low-functioning thyroid?" —Courtiepaigee

    Dr. Yen: "You need to treat the thyroid problem. But you can use birth control hormonal methods with thyroid medication."

    17. "I've had an IUD for almost 5 years and it's about time to change it. I've recently been wondering if there's any long term effects I should be concerned about?" —gej617

    Dr. Yen: "There are no long term effects known from having an IUD in for 5 years. And it is 'known' that having an IUD does not affect your future fertility."

    18. "How uncomfortable is it really to get an IUD inserted or removed? It doesn't seem like it would be all that pleasant to get it inserted or removed so I'm a bit wary of it." —b49a5393c6

    Dr. Yen: "Each person is different and it depends on how you 'feel' your monthly cramps compared to another person with a uterus. It also depends on if you are on your period or not when you get it done or whether your provider uses a paracervical block or not. Generally, I advise women to get it on their period. NOT the first day but the last days — so, like, days 4–5 of bleeding. I also suggest to premedicate with 600 mg of ibuprofen with food 30 minutes to one hour ahead of time. Bring a heat pad, some music to distract you. Ask for the paracervical block. "

    19. "I was told combination birth control shouldn’t be taken by people who have migraines with aura. Why? What are the risks?" —OMGitsaClaire

    Dr. Yen: This is correct. You risk blood clots in your head and thus strokes and death. The CDC has classified migraines with aura as category 4! This is a health risk and this method should not to be used.

    20. "Can birth control help with your period? Like make it lighter and make your cramps go away? I have the heaviest flow, I have to keep changing pads every hour or two, also my cramps are the worst where i can't eat or move that much." —merp626

    Dr. Yen: "You should get checked for a bleeding disorder. That’s a lot of blood. And get checked for anemia, too! Von Willebrand’s Disease is the most common bleeding disorder and often shows up this way — lots of bleeding with the first period or overall."

    21. "Can IUDs “travel” through your body?" —isabelamogo

    Dr. Yen: "They could theoretically perforate through the uterus into the abdomen and then stick into your bladder or intestine. They used to think that it 'wandered there' but most likely it’s from insertion and provider error."

    22. "Is it normal for birth control to cause a lot of white discharge?" —nachocheez

    Dr. Yen: That might be Bacterial Vaginosis, which is not an issue unless it bothers you or you are pregnant and have a history of preterm births. BV is more likely to be brought on by monthly hormonal changes, foreign bodies (e.g. penis, condoms, sex toys), douche, or oral sex. See your provider to get it checked. They can see if it’s normal or abnormal if they have a microscope in their office. (Not all doctors have the microscope)."

    23. "Did taking birth control pills for 8 years or having a copper IUD for 7 years contribute to me now having severe endometriosis?" —profdaniella

    Dr. Yen: "We don’t know what causes endometriosis exactly. But birth control pills are often a treatment for it. So it's unlikely the birth control pills contributed to it. The copper IUD is known to have side effects of heavier periods and more cramps. So the heavier periods might exacerbate the endometriosis."

    24. "Would birth control affect me differently now that I've been in menopause for over a year?" —theKatherine

    Dr. Yen: "If you are in menopause, you don’t need birth control."

    25. "I live in a country with limited pill options, but would still like to be able to control my cycle. Is there any way to take multiphase birth control to prevent or delay your period?" —megh6

    Dr. Yen: "You should be able to stop your periods with any estrogen/progesterone pill. However some pills might be easier than others. The ones with higher progestin effect work better for skipping the monthly bleed.

    To learn more about #PeriodsOptional and how to use the birth control pill or ring to skip or stop periods go here."

    26. "My birth control has completely messed up my cycle. I never know when I’m going to get my period. Is that normal?" — alleycat93

    Dr. Yen: "Are you on the Progesterone only pill, the implant, the IUD with hormone, or the shot? That happens often with progesterone only methods. With the estrogen containing methods — the ring, patch, pill — the bleeds can be under your control."

    27. "I've been on the pill for about 4 years now but I can’t help but notice the libido that came with it. I've been to two OB-GYNs and both have said to just pump up the foreplay, but it doesn't really help. Should I be switched to a different type of birth control or is it the type of pill that I'm on?" —a42dffea4a

    Dr. Yen: "If you are experiencing less libido, then there are 30+ formulations of the pill (with different levels of estrogen and 8 different types of progestins) that you can try that might be better with libido. In general, ones with a more androgenic effect have more libido. But they also might have more acne associated with it."

    Questions and responses have been edited for length and clarity.

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