Is Birth Control Safe? Are Certain Brands Best?

Heather Corinna

On the whole, methods of birth control are safe. Both pregnancy and birth control carry risks, the level of which depend on a range of personal health factors and considerations.

Gwenaly asks:

I’ve
been wondering if using birth control is safe? And is there a certain
brand of birth control that I can use that will be the best to use?

Heather replies:
"Birth
control" or "contraception" simply means any number of methods a person
may or does use in order to try to prevent pregnancy. So, condoms are
birth control. The pill is birth control. IUDs are birth control. The
Depo-Provera shot is birth control. Withdrawal is birth control. If you
choose not to have sex or certain kinds of sex with the aim of
preventing pregnancy, that’s birth control, too. I can’t answer your
question specifically without knowing what form of birth control you’re
asking about.

That said, on the whole, methods of birth control are safe. If they
are prescription medications or surgical procedures they have have had
to pass the rigorous review process any other kind of medication or
procedure must to assure they are safe and effective. Over-the-counter
methods which can be purchased must also go through thorough intensive
review procedures before they can be sold. How much or for how long a
given method has been tested and reviewed generally depends on how long
it has been around for and what a given countries’ standards are for
drug and medical review and approval.

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You can get a basic idea of what
that process is like for medications of all kinds in the United States here, and can find out what that process entails for medical devices (like condoms or cervical barriers) here.
Often, when a user here says "birth control" they’re referring to one of the combined hormonal methods: to the pill, patch or ring.
Know that the pill is actually one of the most studied medications
we’ve got: resistance (mostly of the political or religious variety) to
it when it first was in development resulted in more rigorous testing
and study than we’ve seen with nearly any other medication I can think
of, so we can be very sure it is safe
overall, surer than we can for many other medications out there. You
can even find information on clinical trials of the pill just by
looking online dating as far back as the early 60’s.

On the whole, hormonal and surgical birth control methods (like the
IUD or a tubal ligation) pose more potential health risks from the
method itself than non-hormonal methods do. How safe any method is,
though, differs both from method to method and from person to
person. For example, for certain women with specific health conditions
(like an existing cardiovascular problem) or health history, or who are
members of a given group (like women over 35 and/or who smoke, or who
already use other medications where using a hormonal method could
potentially create a dangerous interaction) a method like the combined
pill poses greater risks than it would for women not in those groups
and/or for women not using that method. The risk of some types of heart
disease, for instance, for users of the pill was shown in one recent
study to be 2.5 times higher than for non-users. However, that was much
more likely for women using the pill who are over 35 and/or who smoke.
For those who aren’t in one or both of those categories, there may be
little to no elevation in those risks at all compared to non-users.

I think it’s important to point out that pregnancy and childbirth also
present health risks, side effects, and potentially serious impact on
halth. Preventing pregnancy, in and of itself, protects a woman from
many possible or actual health risks, some of which are very serious.
Most methods of contraception, are, in a broad way, safer than
pregnancy.

I appreciated that the health writer for this piece at ABC made the connection between serious risks of hormonal contraceptive use and that of pregnancy. She points out that:

Studies show pregnancy is linked to a two- to three-fold
increase in the odds of heart attack, an eight-fold increase in the
odds of stroke, and as high as a 50-fold increase in the odds of blood
clots. Hormonal birth control pills look quite safe by comparison.

Here’s a basic overview of some very typical temporary health
effects of pregnancy most women experience: things like nausea and
vomiting, dizziness and light-headedness, hemmorhoids, yeast and
bacterial infections, increased headaches, swelling of joints and joint
pain, difficulty sitting or standing, shortness of breath, higher blood
pressure, hair loss, post-partum depression and pain with delivery.

Some typical permanent health/body changes many women experience with
pregnancy are stretch marks, pelvic floor disorder, varicose veins,
scarring from episiotomies or c-sections, increased proclivity for
hemmorhoids and loss of dental and bone calcium. Some less common
health issues or complications which occur for women with pregnancy
include hyperemesis gravidarum, temporary or permanent back injury,
pre-eclampsia, placenta previa or placental abruption, obstetric
fistula, anemia, gestational trophoblastic disease, blood clots,
cardiopulmonary arrest, mitral valve stenosis and gastroesophageal
reflux disease. And far less commonly, things like becoming infertile,
developing permanent disabilities or, again, death.

Pregnancy, overall, carries and statistically results in more health
problems than any current method of birth control does, especially if a
pregnancy is carried to term and a woman gives birth, and especially if
the method of birth control being used is being used properly, by
someone who is in general good health, and by someone who is a good
candidate for that method. Pregnancy can also carry even more risks for
younger teens or older women than it can for women in their twenties
and early thirties.

Around 40% of all women who become pregnant have some kind of health complication during the course of their pregnancies.
People tend to forget that, forget to mention it (especially when
talking about the risks of contraception), and some don’t even know in
the first place.

In the United States in 2004, according to the Centers for Disease
Control, there were 13 per 100,000 pregnant women (540 women total) who
died from pregnancy or labor. Compare that to, say, FDA reports of 17
women who had used the patch who died from heart attacks, blood clots,
and possible strokes since August 2002 (in a seven year period), which may have been related to the patch (but also may not have). Or to 50 reports of deaths to the FDA which may
have been connected to the Yaz or Yasmin birth control pill since 2004
(in a five year period). Even if, for both of those methods, those
deaths all were directly connected to the use of those
contraceptives, we’d still be looking at a much smaller rate of death
as compared to pregnancy. Whether you become pregnant, or you use some
methods of birth control to try and prevent pregnancy, you risk death,
the risks of death are just lower for contraceptives than pregnancies.
But let’s be real: we do all risk death simply by living in the first
place.

None of this is to say that people who want to be pregnant should
all steer clear because there are some health risks, even though some
of them are very serious.

Pregnancy — like using contraception AND having sex with partners
at all — is just one of those things in life where, when it is about a
choice we actively make, we weigh the things that aren’t or may not be
healthy, good or wanted with the outcomes or experiences that can be or
are healthy, good or wanted, and make our choices based on if we think
the possible good outweighs the possible bad. Many risks pregnancy
poses, just like the risks some contraceptive methods do, can also be
managed to some degree so that they are less likely. I’m not trying to
scare anyone from wanted pregnancy, nor from contraception (or sex for
that matter). I’m simply pointing out they all carry health
risks, and when considering the risks contraception may pose, I think
it’s important to know that pregnancy poses risks, too, and usually
greater or more prevalent risks than methods of birth control tend to.

Death obviously isn’t the only possible health risk or side effect
whether we’re talking about pregnancy or contraception (or sex, for
that matter). As it is with pregnancy, many contraceptives also present
some risks, too. To give you a general idea, with combined hormonal
contraceptives like the pill, patch or ring, we’re talking about risks
like the heart-related risks I already mentioned, allergic reactions,
gallbladder disease, nausea, shortness of breath, mood changes
(sometimes severe ones), changes in libido (sexual desire) or eye
problems.

Progestin-only methods like a Depo shot or implant can
present those same kinds of risks or side effects. With IUDs, risks can
include a higher possibility of developing pelvic inflammatory disease
(especially right after insertion), perforation of the uterus, cramping
or abnormal uterine bleeding. Cervical barriers, especially diaphragms,
can make it more likely to get urinary tract or bladder infections.
With something like condoms, spermicides or sponges, the risks from
those methods directly are most often just allergic reactions or
(genital) irritation. For a method like withdrawal or natural family
planning, since you’re not actually taking any medications or putting
anything inside your body, the only real health risks for those are
those associated with pregnancy: in other words, if we consider
pregnancy a health risk, that’s what your sole health risk is with
those methods, but only if they fail. Of course, especially with any
method that is not a latex barrier — while the method itself doesn’t
present this risk, the sex itself does — sexually transmitted
infections are technically health risks, too.

However, just like women can reduce their health risks with
pregnancy by making choices about how they take care of themselves, at
what time in life they become pregnant, and how they manage their
pregnancies, so can women with methods of birth control. Not all
methods are the right or best choice for everyone or the safe choice
for everyone.

That’s why many methods need to be prescribed by a physician. That
healthcare provider should sit down with you and look at your health
history, your current health and lifestyle, and make sure anything they
prescribe or dispense for you is as safe for you as possible. Your
heathcare provider is someone you can talk to about safety even with
methods they don’t need to fit, perform or prescribe, too. When you’re
talking to them, if you’re as honest as possible about your health and
lifestyle, and as detailed as you can be about all of that and your
health history you can play a part in helping them help you choose the
safest methods for you. By all means, if you wind up with a healthcare
provider who doesn’t seem to take much time with all of that
information, or who just tosses a method or brand out you without
seeming to consider you as an individual, find yourself a better
caliber of provider.

When it comes to methods that have different brands (like the pill)
or types (like the two kinds of IUDs), your doctor should do their best
to choose the brand they feel is the best fit for you. For example, a
copper IUD can be kept in for ten years and does not lighten or result
in missed periods, and also is totally non-hormonal: for women who want
that kind of long-term use, don’t want hormones, and/or want to
continue menstruating, that’s going to be the best choice of IUD. But
that kind of IUD can also make periods heavier or cramps more intense,
so for women with painful or heavy periods already, or for those who
want less periods, lighter periods, or pain relief from cramps and are
okay with an IUD they’ll need to replace in less time, the Mirena will
be the better choice.

When we’re talking about brand differences, we are usually talking
about birth control pills: most other methods don’t have any or a lot
of different brands and types (with the exception of condoms).
Combined oral contraceptives differ when it comes to the specific
level, kind and combination of hormones. Those differences in dosage
and kind are usually pretty minor with pills these days (and all
current pills are "low-dose" if that’s a term you’ve heard), but those
tiny variations can make a big difference with some women.

If you’re
choosing a method where there are different types or brands, what is
best for you is going to depend on you, and a good healthcare provider
will do their best to choose a brand they think will suit you best as
an individual. If you want a general reference for yourself, here’s a good page
that talks about the difference between some brands of birth control
pills and also lists which brands can be better with certain unwanted
side effects or other health issues. Looking at a page like that can
also give you some information about what to ask your doctor about,
too. If you are particularly worried about mood changes or headaches,
or would like your pill to also help with menstrual cramps or acne,
it’s great to mention those things during a birth control consultation.
Know that sometimes, when we’re talking about pills or methods in
general, it can sometimes take more than one try to land on the method
or pill that you really like most.

It should also be mentioned that some methods of contraception have or may have protective
or positive effects: this isn’t all about risks of negatives.
Obviously, preventing pregnancy and the risks associated with pregnancy
is one of them. But oral contraceptives, for example, can or may also
help prevent "cancers of the uterus and ovary; ovarian cysts; pelvic
inflammatory disease; bone loss; benign breast disease; symptoms of
polycystic ovary syndrome; ectopic pregnancy; and anemia (iron-poor
blood)." (from the ACOG).
As you probably already know, condoms can protect you from all known
sexually transmitted infections. Methods of birth control can also have
some extra health bonuses: for example, many women with painful periods
can have some or all of their pain relieved with some methods, others
can help clear up some kinds of acne or help with endometriosis. To
keep this balanced, pregnancy can or is suspected to pose some
protective factors per women’s health, too. For instance, pregnancy is
known to decrease the risk of breast cancer, may result in a period of
remission for those with rheumatoid arthritis, and can sometimes
provide relief from multiple sclerosis symptoms.

Long story short, whatever choices you make with partnered sex and
reproductive choice — be that with pregnancy or in preventing
pregnancy — you’re looking at some potential health risks, at some
things which may not be safe, or as safe as if you didn’t have sex with
a partner at all. By all means, it’s very important to consider your
health in the sexual, reproductive and contraceptive choices you make.
Once more with feeling, your sexual/reproductive healthcare provider is
the very best person to address those concerns with, and to look to for
help in figuring out what’s the most safe for you. You can pair that
with some consumer research of your own, which you can do by looking at
sites like ours, the manufacturer pages for a given type or brands of
method, and at credible consumer reports, and with great women’s health references like Our Bodies, Ourselves. We also provide a thorough walk-through of all available methods that you can do for yourself here.
Doing that could be a good thing before you see your doctor (if you’re
going to want a method where you need to), so you can walk in with some
idea of what you think you’d like to try.

The safety of contraception — especially when you understand
pregnancy generally poses even greater risks — is one big factor to
consider when making your choices. It’s probably obvious, but you’ll
also want to consider if you do or don’t want to become pregnant and/or
parent at a given time, and if you do or don’t want to be having sex
with a partner. If you do decide you want to have the kinds of sex
where pregnancy is a risk but also decide you don’t want to become
pregnant, then in considering methods of birth control, along with
safety, risks and possible side effects, you also want to consider
effectiveness, ease of proper use, cost, accessibility and a whole host
of other important factors to find the very best method or methods for
you.

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.