The Vulvalution

#7 What birth control is best for me?

• Season 1 • Episode 7

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0:00 | 1:33:23

Choosing birth control can feel overwhelming—so we’re breaking it down. In this episode, we’re joined by nurse Claire Frampton to walk through all your options, from the pill and patch to IUDs and implants, and what actually matters when choosing one.
We cover effectiveness, side effects, hormones, periods, and the questions everyone is asking—like how birth control affects mood, whether you can skip your period, and which options are best if you want to avoid hormones.
Whether you’re starting, switching, or just curious, this is your no-BS guide to birth control.

**Please note at 1:02:20 Claire accidentally says "tonsils" when she meant "wisdom teeth."**

📚 Episode Resources:
Medisafe Medication Management App – A free app that helps you stay on track with your medications, including daily birth control reminders: https://apps.apple.com/us/app/medisafe-medication-management/id573916946
Sex Sense (Options for Sexual Health) – A confidential, evidence-based resource call line offering information and live support on sexual health and contraception: https://www.optionsforsexualhealth.org/sex-sense/
Scarleteen – A platform providing inclusive and accurate education on sex, relationships, and reproductive health: https://www.scarleteen.com/about
Planned Parenthood – A leading provider of reproductive health care and education, with detailed information on birth control options and sexual health: https://www.plannedparenthood.org/

Chapters:
00:00–01:06 Trailer 
01:06–03:35 Introduction 
03:35–08:22 What Is the Best Contraceptive Method? 
08:22–10:13 How Does Birth Control Work? 
10:13–19:30 Least Effective Methods (Condoms, Diaphragm, Withdrawal, Fertility Awareness) 
19:30–21:15 Condoms 
21:15–42:15 Birth Control Pill 
42:15–46:00 Vaginal Ring 
46:00–47:20 Patch 
47:20–52:00 Injection (Depo-Provera) 
52:00–01:05:05 IUD 
01:05:05–01:09:45 Implant 
01:09:45–01:19:30 Tubal Ligation 
01:19:30–01:23:23 Systemic Hormones 
01:23:23–01:26:02 How to Choose the Right Birth Control 
01:26:02–01:27:53 One Thing You Wish More People Knew 
01:27:53–01:29:00 Resources 
01:29:00–01:33:23 Conclusion

Claire

when there's nuance, when there's a gray area, when the person that you go to to get started on birth control says, well it depends. That's actually a good sign. Even though uncertainty is so uncomfortable I find it helpful to talk about, okay, what happens if you get pregnant? Like, is getting an ab*rtion an option for you?​It Isn't necessarily trying to make the perfect choice or the right choice. I actually think that that's an unfair goal to carry, but the best possible choice with the information that we have now.

Part 1

I know With social media and everything that we see online. the pill is not. having a good rep right now. Could you talk a little bit about the side effects or risk and what is real and maybe what is not real?

Claire

Why don't we provide more pain management for inserting IUDs?​So now we'll move on to the vag1nal ring. So could you you explain a little bit like how it works? Can do people feel it? It?

Sabrina

What is the best option of birth control if you want to avoid systemic hormones, and also avoid the pain of getting an, IUD

Claire

Welcome back to the Vulvalution. So we're so excited for today's episode. We're talking about contraceptive. So we know there's so many different contraceptive method in Canada that are available just but we wanna know what's really best for us. Yes. So how do they work? What are the different options, and which one is really best for you? Today we are joined by Claire Frampton, a registered nurse who works for Options for sexual health. Claire is also a student at UDC, working towards becoming a nurse practitioner.

Mathilde

And

Claire

you do wanna disclose that today's Claire is talking about her views and they do not reflect those of any of her affiliated organizations. So welcome to the Ball Volution, Claire, thanks for having me.

Mathilde

So excited

Claire

for you to be here today and this topic, especially, we've had so many requests to do an episode on, so glad to finally be getting into it. So tell us a little bit more about you and what brought you into the sexual health and contraceptives field. Thanks for asking. Well, I'm a, a big sexual health nerd and I would be talking about this stuff otherwise, even if I wasn't on a podcast, so thank you so much for the microphone. So I did a, a social sciences undergrad in Ottawa, which is where I'm from. And, I did co-op placements and I got, had like a scholarship and so I had all this extra money at the end of my program. And I like lived at home, so I saved money and any reasonable person would've taken that and gone backpacking somewhere. But I decided to do the check program at Options for Sexual Health and traveled to Vancouver for the first time. And, you know, learn how to do sex ed. I had hoped that it would inform my master's. Like I was just gonna go back and do a master's. And then I fell in love with Vancouver and I fell in love with sexual health and options for sexual health as an organization. Um, and I moved here and I started working for options. And then the leap into nursing was truly because I worked with some really badass nurses and I thought, I wanna be like them. I'm gonna go to nursing school. So, um, that's, that's the process. Beautiful. Yeah. Transition. Oh, yeah. Yeah, it was great. It's,

Sabrina

It's great. It's,

Claire

you know, everyone finds their way in a different way and yeah. Mm-hmm.

Sabrina

Absolutely. Yeah.

Claire

okay.

Mathilde

So

Claire

for this episode, one of our biggest question that we got from people and that we have ourselves is what is the best method of contraception for us? How do you approach answering this commonly asked question? Thank you so much for asking. I cannot tell you how much I think about this. it would be so easy if I could just tell you the maneuvering is for you and you the pill, but it is not that simple. And I actually think that that's a good sign when there's nuance, when there's a gray area, when the person that you go to to get started on birth control says, well it depends. That's actually a good sign. Even though uncertainty is so uncomfortable, right? And it's, I would say, an equally bad sign if people have that unearned confidence, that like certainty that they're pulling out of nowhere. If they're like, take this supplement and it'll cure your symptoms overnight. A hundred percent guarantee. Or they say to you, well I just start everybody on the pill. That's everybody's first birth control. Cause I'm their nurse practitioner. And I said, so, um, what we actually wanna do is compare the options and go through a process that. It Isn't necessarily trying to make the perfect choice or the right choice. I actually think that that's an unfair goal to carry, but the best possible choice with the information that we have now. Mm-hmm. That's what I'm always aiming for, so I have a, like a systematic process. First, I wanna know, do we have any, like good medical reasons why you can't use some forms of birth control? There are certain, contraindications is what we call them. So really good reasons that somebody shouldn't be on a pill with estrogen in it or somebody like, shouldn't have an IUD, then we don't have to worry talking about those ones. Right? Then I wanna know what do you want out of your birth control? What do you not want out of your birth control? That'll help me whittle it down more. I also wanna know what information are you bringing to me that I don't have? Like I, I know in theory what birth control does what, and you know, what might be a good fit, but people know themselves best and I want to know. Like what is their risk tolerance around certain side effects? What is something that they absolutely wouldn't consider, or what misinformation maybe they have about, what's involved in using a certain, method of birth control and can we shift some things? Can I tell them about options to make something more accessible? Mm-hmm. So the approach is that it's a process. Mm-hmm. It's not like instant gratification. And then if I may add,

Mathilde

mm-hmm.

Claire

this is where I get on my soapbox a little bit. So I really think that a practitioner's job is what I've been calling risk stewardship. So if you're coming to me and you're saying, I wanna use this form of birth control, I'm gonna give you all the information that you need to know about that birth control, we're gonna talk about the alternatives. We're gonna compare the risks and benefits, and then the decision is yours. And I don't really have a stake in that. Like if, even if it's not, it wouldn't be my top choice or it wouldn't be my top choice for you, even whatever choice you make, I stand by you for the consequences of that choice. So if you are choosing to use, let's say, like a less effective form of birth control and then it doesn't work, you happen to get pregnant, there's no, I told you so there's no gotcha.

Mathilde

Mm-hmm.

Claire

If you come to me and, and I say, well, the most effective form of birth control in Canada is the implant. And then you try the implant and you hate it, I'm not gonna be like, well, it's really effective,

Sabrina

Yes.

Claire

so you should like it. Your experience should be different. My job is to walk with you through the consequences of whatever choice mm-hmm. You make. And as long as we're deciding we're making the best choice that we can with the information that we have now. If things go sideways or they're not ideal, then you come back to me with more information. We have the opportunity to make another best choice. So there's no like buzzfeed quiz,

Sabrina

Mm-hmm.

Claire

do you know what I mean? Like it's a, and also there's no, there are very few wrong answers. Mm-hmm. Like most people are eligible for most options. Yeah. It's very personal. Yeah. Choice that you're, no, but I really like that whole stewardship, uh, yeah. I just, I'd made this up. I call it risk stewardship. I don't know it, maybe that doesn't speak to it, but, I just think about it as like. I recognize the vulnerability of every client who comes in to try any medical intervention. Mm-hmm. Birth control, especially because it's so politicized and it's so personal and there's a lot of misinformation about it and it like has to do with a stigmatized area of life, like sexual and reproductive health. And so I recognize that vulnerability and that every medical intervention is a risk. You're taking a risk for some benefit. And I would never fault anyone for if it doesn't go well. Yeah. Yeah. I love that. Yeah. Okay. Outside of just preventing pregnancy mm, what are some general things people consider when choosing a contraceptive? Yeah, it's a good question. Birth control does a lot of things. Also, we call it contraception, to make it clear, but we're using it as treatment for lots of different conditions. Yeah. So even people who aren't sexually active or sexually active in a way that could get them pregnant are on contraception because it can do so many things. So, um, the big one is menstrual changes. So if somebody has really heavy periods, if they have endometriosis or if they have polycystic ovarian syndrome, if they are anemic, if they lose a lot of iron with their periods and they're just having such a hard time replacing it, sometimes if we use a birth control that suppresses menstruation, it can really help them get ahead of that iron loss. So there's lots of different things. It can be supportive for mental health in different ways. So, if somebody has PMDD, which is a more intense version of PMS, with like very specific diagnostic criteria. Sometimes we do also put them on a form of birth control to help with that. So there's a lot of things to consider. So often people do come to me and they're like, I just don't wanna get pregnant. And then I'm like, oh, you know, okay. Anything else? Uh uh Or they come to me and they're like, I don't really care about that. Or, you know, it'd be nice to have contraception, but what I'm really concerned about is acne, for example, some birth control can reduce acne. So it's really not just not to get pregnant. Yeah. There's so many different,

Mathilde

so many. Yeah.

Claire

oh, and even like the perimenopause and menopause period period when pregnancies, like in perimenopause, very unlikely. And then in menopause, not possible. We're using IUDs. Did you know this? Yes. Oh my gosh. We love A hormonal IUD for menopause So it can even be part of menopause treatment. When pregnancy is not even Yeah. On the table. On the table,

Mathilde

on the table.

Claire

yeah. Okay. So, so many different uses. I feel like we're gonna talk so much about lots of different things. Mm-hmm.

Mathilde

Yes. It's so true. Shall we get into it? Let's, yes. Okay. So for this episode, we wanted to organize our discussion into different contraceptive methods and effectiveness. So we wanna start by talking about the least effective methods, which is not necessarily the BAP method, just like the least effective. So these are methods just as condoms, the diaphragm, or the withdrawal method, which is what we know as the pullout method. And then there's also the fertility awareness method that we'll talk about. So, according to options for sexual health, on average, there's about 12 to 24 out of a hundred people using these methods that get pregnant So

Claire

year. Per year, per year abuse.

Mathilde

important.

Claire

Yeah. Um, not

Sabrina

forever.

Claire

Yeah. That would be really good in like a lifetime of somebody using this method. that would be pretty good. Yeah. Mm-hmm. But yeah, per year. Okay. why are these methods less effective? The, the short answer is user error. And I don't mean to sound like blamey about that. It's just that these methods require a certain amount of skill and then also luck. So you need a certain amount of skill with the withdrawal method. Like you have to have quite a lot of body awareness and you also need to be able to trust your partner to be good at this. If you're not the person making the sperm, um, you need to be able to buy and store condoms effectively. Like you can't put a condom in your pocket and leave it there for two weeks and then the trust that it's not gonna break. But also sometimes they just break. Sorry, can I stop you here? Yeah. I didn't know that. Yeah. Yeah. Like

Mathilde

because you have to store it at like a

Claire

it's the warmth. Yes. It's the warmth of the body. Oh, interesting. So like heat and oil breaks down condoms. So if you have one in your pocket for two weeks, it's probably gonna break. Yeah. Or if you like have an oil-based makeup, lipstick or lip balm on mm-hmm. And then that gets onto the condom. It will start eroding it. Isn't that wild? Yeah. Um, or if you're like, oh, I forgot to check the expiry on these con, like, there's just, it's just another thing to think about.

Mathilde

Mm-hmm.

Claire

The other thing is that, it's about being consistent. So like humans have a hard time being really consistent. We will talk about this more with the pill, taking the pill, um, but you're really fighting against time and so many variables. So it's it makes sense that they don't work as well. Yeah. Okay. And that number that we quoted 12 to 24 mm-hmm. Was different for the different methods. Mm-hmm. Mm-hmm.

Mathilde

Which of those is the more effective

Claire

I, that's a great question. I think what I wanna say about them is, it's quite variable based on how good you are at it and how consistent you are at it.

Mathilde

Mm-hmm.

Claire

Um, each one and also. One thing I'll say about the fertility awareness method is if you're somebody who has a really stable, consistent life and a predictable menstrual cycle, which is not everybody, it's much easier to do. But if you're like, what if you're somebody who travels to a different time zone every other month, like that's gonna, it's gonna be so much harder to do fertility awareness. So, so yeah, these are really, really context specific ones, whereas ones that we'll talk about later are sort of more buffered from those variables and buffered from user error, and that's part of why they're more effective. Um, and then also partially just the technology involved. Okay.

Mathilde

Okay.

Claire

Yeah. And when we talk about fertility awareness mm-hmm. Like the apps that we're using and to know when you're all relating. Yeah. It didn't used to be apps. It literally, people could do it on a piece of paper and they did.

Mathilde

Mm-hmm.

Claire

And if you're really, really consistent, it, it can be quite effective. But it's never gonna be as effective as something like an IUD or an implant. The apps I will say can be very helpful because we all have a phone in our pocket and you don't have to like lose the piece of paper that using to track your ovulation. And it can be more powerful if you're logging your morning temperature before you get outta bed, like your oral temperature. Um, and also you're like checking your cervical mucus and then you can log that. But the apps definitely make promises around, effectiveness that I feel dubious about. Whenever we're doing research, we have to be very careful about who's funding that research, what their investment is, and the outcome of that research, how rigorous they are. So. Whenever I, I call it sniffing the data, like whenever I sniff the data that informs these apps, like the claims that they're making around fertility awareness, something smells funky.

Mathilde

Right.

Claire

I just, They're trying to get people to use their own app. Yes, for sure. And so they'll say like, oh, it's as effective as a birth control pill, and it's just, we do not have the evidence to suggest that. Mm-hmm.

Sabrina

Okay,

Claire

Like if you were really bad at taking a birth control pill and really good at doing fertility awareness, maybe that's true, but when we're talking about like a population level of, a hundred people are using the app, a hundred people are using the birth control pill, we're just not gonna see the same effectiveness with fertility awareness. Okay. And generally speaking, who might be a good fit for these sort of lower. Effectiveness, contraceptive methods. That's another thing I love talking about. So, okay, so when I was training in sexual health and still the training in sexual health talks about reproductive desire as a binary. People either are like really wanting to get pregnant, actively trying, or they do not wanna get pregnant. They will go to the ends of the earth not to get pregnant. And that's just not how the world is and how people are. It's complex. So there is something called ambivalence in reproductive desire. Like people are sometimes ambivalent about wanting to get pregnant and that's valid and fine. If we're saying that, you know, your body, your choice, that's part of it. You're allowed to be ambivalent about it. So I definitely have clients who come to me and they're like, well, I don't really wanna like put my all into trying to get pregnant right now, but if it, it happens, like, great. And so. For these lower effectiveness methods, especially ones that don't carry hormonal side effects, which I guess is all of the ones that we're talking about right now. Um, like, great, sure. Like if, if, you're happy, I'm happy. Again, it's about informed consent. If you know the risks and benefits and if you know that one of the risks is this many people in a hundred per year will get pregnant and that there are more effective methods available, but actually if you did get pregnant, it'd be fine. It wouldn't be the end of the world for you. Um, great, I'm happy. Mm-hmm. Yeah. Yeah. I think that's such an important thing to talk. Mm-hmm. And I think you're right that it's not a binary, some people are in a position where they're like, I'm not actively trying to have a child necessarily. Mm-hmm. But if I did, I wouldn't be mad about it. Yeah. So

Mathilde

So I think that's a really important,

Claire

And I'll, I'll say one more thing. So there are folks who just cannot tolerate hormonal birth control of any kind, like they're not able to tolerate the risk of having hormonal side effects, or they've tried hormonal methods and have had a bad time if all that's left for them, like once they've exhausted all their other options, is the withdrawal method or the fertility awareness method. Like I think those are useful for those folks better than a hundred percent chance of pregnancy. Yeah, And I,

Mathilde

I really,

Claire

I think it's tempting as a healthcare provider for somebody to come in and say, oh, I'm using the fertility awareness method and we are taught to make sure that people are aware. It's important that people are aware that they have really effective options available. But I would really caution healthcare providers against rolling their eyes and saying, oh, the withdrawal method, like,

Mathilde

mm-hmm.

Claire

well, call me when you get pregnant. I think it's very easy to fall into that pattern, whereas I actually think that people are making the best choice that they can with the information and the resources that they have. If somebody comes to me and they say, I wanna use the fertility awareness method, you know, I have my reasons for not wanting to consider any other options, I will support them as their healthcare provider. Of course I will. Of course I will. Okay. Yeah. I like your point of view because I have a lot of friends that went to the doctors and they told their their doctor that. they're not On anything and they don't wanna be on anything. Yeah. And they got the like

Mathilde

eye

Claire

rolling and just like, alright, well you know, you know the risk. And just like as if it was their decision that, you know, you're gonna get pregnant, but don't call me for anything like, yeah.

Mathilde

It's sad.

Claire

And

Sabrina

And

Claire

what I would say is if somebody did come to me and they were using a less effective form of birth control, whether they knew it was less effective or not, and they did happen to get pregnant, the way that I would interact with them is the exact same as if they came to me and they're, you know, one of the very few people who got pregnant with like an IUD or um,

Sabrina

Or

Claire

they were pregnant for any other reason. We have the exact same conversation with everybody, or we should,

Sabrina

Mm-hmm.

Claire

and that is okay, we confirm that you're pregnant. How are you feeling about this pregnancy? What do you want to do next? Do you know what your options are? We'll talk about the options, which is continue the pregnancy and make a plan for parenting. Either your parenting someone else's parenting, or you can. can end the pregnancy with a safe, routine medical procedure that is covered by MSP called an abortion. And then we help arrange that. We do not need to go into, well, why weren't you on birth control or mm-hmm. It's just not necessary. It's not helpful for the therapeutic relationship. It's not helpful for the client.

Sabrina

Yeah.

Claire

Wholeheartedly agree. Mm-hmm.

Sabrina

Mm-hmm.

Claire

Okay. Before we move on to some more effective methods, I do wanna also give you the opportunity to explain why it's also important to use condoms as in addition to Oh, yes. Yeah, yeah, yeah. So the, the other thing, condoms give us something that no other form of birth control gives us, which is STI protection. Incredible. I also find that some people, even when they're on the birth control pill, they just feel better when their partner's using a condom. And I think part of it is the STI protection for sure. But there's also just something like psychologically comforting to a lot of people about condoms, which I, I just wanna say is valid. Yeah, yeah, yeah.

Sabrina

yeah.

Claire

Um, condoms also get such a bad rap people associate condoms with actually less sexual pleasure. But some folks have the opposite experience and a lot of it is like, whatever you think the condom will do for you, it probably will in terms of like reducing pleasure or increasing pleasure. But there's so much opportunity there for, um, like if you're less worried about STIs, you're less worried about pregnancy, you're having more fun. Yeah.'cause your brain isn't elsewhere.

Mathilde

Mm-hmm.

Claire

Um, you put a drop of lube inside that condom, and then now things are shifting around in a different way. That can be fun. Putting on the condom can be, part of sexual play. So I think that latex payers in general get a bad rap. Around not being like fun or pleasurable, but I think that just means we're not being creative enough. Mm-hmm. Love. Yeah. Anyway.

Sabrina

love

Claire

Yay. Condoms. Yeah. Forever use condoms. Even if you're using another conscious, don't leave them in your pockets for too long.

Mathilde

Yes. Yeah.

Sabrina

Yeah.

Claire

Yeah. Yeah. I'm, I'm glad to get the word out there. They don't, they don't belong in your pocket. Perfect.

Sabrina

Unless

Claire

it's like you're on your way somewhere and you need some more to Yeah, yeah, yeah. Short term. Short term. Yeah. For sure.

Mathilde

it.

Claire

Bring it.

Mathilde

Yeah. Okay.

Claire

Moving on to some more effective contraceptive methods. So next we're gonna talk about the pill, the ring patch and the injection. So

Mathilde

average,

Claire

about six to nine out of every a hundred people using these will get pregnant for a year. Mm-hmm. Which is better than the ones we mentioned. Um, but not perfect, of course. So let's start by talking about, the pill, which I think is a big topic, especially online with a lot of misconceptions. So I'm really excited to talk about this. Can you start by just telling us what is the pill? How does it does it work? Yeah, so the birth control pill, there's two kinds. There's one with estrogen and progestin in it, so two hormones or the combined hormonal contraceptive pill. And then there's the progestin only pill, so that only has one hormone in it. And they do different things, but also kind of the same thing. So the combined hormonal contraceptive pill, it's stopping ovulation from happening. The progestin only pill sometimes also does that, but not reliably. The thing that progestin does, whether it's in a combined pill or the progestin only pill, which is that it thickens the cervical mucus. And then also over time, it'll thin the endometrial lining, making it less likely that a fertilized egg could implant. So it's kind of doing a few things. Okay.

Mathilde

Mm-hmm.

Claire

There are different considerations. So estrogen tends to be like if somebody is medically ineligible for a kind of birth control, it tends to be that they can't have the estrogen. So things like migraines with aura, if they've ever had a venous thromboembolism, so like a dangerous blood clot, if they are over 35 and they also smoke cigarettes, if like, there are all these medical contraindications for estrogen based birth control. It used to be that progestin only pills were sort of a, a constellation prize if you couldn't have your estrogen based birth control.

Mathilde

Um,

Claire

the reason why is. With the progestin only pills, you would have to remember to take it within the same three hour window every day. Whereas with the combined pills, you get a 24 hour wiggle room. So we don't consider that you've missed a pill until you've missed it by 24 hours or more. But now there's a new, there's a new progestin only pill in town.

Sabrina

Okay. And

Claire

it's a new form of progestin called

Mathilde

Sperone.

Claire

Uh, the brand name I think is Lind. They're not paying me. But the difference there is that people can have that same wiggle room of the 24 hour period, with that newer progestin only pill. Sorry. What happens if you are previously, if you were outside of that three hour window is like

Mathilde

that

Claire

a missed pill

Sabrina

a pill.

Claire

And as it like reduce effectiveness. Okay. Yeah. Yeah. So you mentioned

Mathilde

a lot about like who would be good candidate for the progestin only pill. Mm-hmm. Like if you have migraine but then I was wondering who would be a good candidate for the pro? Mm-hmm. just estrogen. Pill? Yeah. So, because we're reliably stopping ovulation, that tends to treat a number of conditions that are related to ovulation. So some people, like if they have PCOS, if we stop ovulation, they hopefully will have fewer cysts. Estrogen also has, uh, and some progestins as well, have what's called an anti anergic effect. So it opposes testosterone. And so if you're having like unwanted facial hair or body hair or if you're having acne or those sort of like testosterone based concerns, it can be really helpful also. It, you want really regular periods, like if you've always had a really irregular period, the pill sort of sets a schedule for your body to have regular bleeds, which some people really want. It can also be an option. Maybe not our most powerful option, but, certainly an option to have less bleeding, like lighter periods, lighter predictable periods.

Claire

Okay. And what about people who have serious cramping?

Mathilde

Is it a good option?

Claire

Yes, it can definitely help. So, because it's gonna thin that endometrial lining, there's just gonna be less to cramp out, less, uh, shedding of the endometrial lining. So it can be, yeah. A powerful option for those folks. It's, you know, one of our first lines for PCOS endometriosis. It can, it can really help, it can also help with PMS and PMDD. So because it's, it's sort of like shutting down ovulation, thereby reducing the rollercoaster of your menstrual cycle is how I tend to describe it, right? Mm-hmm.

Sabrina

Okay.

Claire

And there's lots of different variations. Mm-hmm. How much

Mathilde

estrogen

Claire

or progesterone there are in a combined pill. What is the difference and why might people want one versus another? Yeah. I encourage people not to worry too much about that. Like a lot of it is marketing. Just know they all are effective for preventing pregnancy. Some of them have specifically been studied for certain indications, like acne treatment. I have on the cork board of my clinic. Uh, chart that shows me like if somebody is having this side effect on their birth control, you might consider this pill instead. If someone's starting pills for the first time, it's kind of dealer's choice. Like, I'm not as worried unless they really want something that's been studied for acne or, they really want like a newer generation for whatever reason. People come in and they say like, I know it's silly, but my best friend is on this pill and she's having a good time and I wanna use that too on. As long as they don't have medical contraindications to the pill. Like it's not, it doesn't actually give us evidence that it'll work for that person. But I think that the way that people feel about their birth control matters, and if they're excited about that, cool. If they understand that, like the effectiveness, the risks, the benefits, and they're just stoked to be on a specific pill, like that's a actually a good enough reason for me to choose one over the other. Okay.

Part 1

So you mentioned a little bit like there are some side effects I know mm-hmm. With social media and everything that we see online. the pill is not. having a good rep right now. Could you talk a little bit about the side effects or risk and what is real and maybe what is not real that we've been seeing online? Yeah, for sure. I mean, I think in general, so what, so when we study pills, we ask people who take them, you know, what side effects have you had? And then we list them all and how often they show up

Mathilde

mm-hmm.

Claire

In the study. But if somebody came to me and they're like, ever since I started the pill I'm having this side effect, or I feel this way, I tend not to say, well it's not in the research or, you know, what are the chances of that? Only 5% of people had that side effect. I think it's all in your head. I'm never gonna say that. I'm gonna say you're not happy. Let's, we can try something else or we can talk about the risks and benefits of trying something else, but like the common side effects that come up. Are things that we think of as related to PMS. So like headache, abdominal pain, maybe they'll have breast tenderness. Maybe they'll have mood swings. But there's also, technically, like if you take the pill for contraception and you have really light regular periods, that's a side effect. Because that's not the main effect of the medication. That's all side effect means is it's like an extra thing. So there are, there's a big difference between desirable side effects and undesirable side effects. And that's so subjective, right? So some people come to me and they're like, oh, I don't even get my period on the pill. And they're like, that's great. And some people are like, I'm not getting my period on the pill. I don't like that. So it's, it can be very subjective

Mathilde

okay. So obviously taking the pill every day requires a lot of being able to do the same thing every day at the y'all. It's so hard. Yeah. Um, what happens if someone misses a pill? Okay,

Claire

so if you miss a pill, it depends on what week of the pill pack that you're in, how much it reduces the effectiveness of your medication. I know that that's interesting. Isn't that wild? So what I recommend doing is if it's between Monday to Friday, 9:00 AM to 9:00 PM call sex sense.'cause they will do the, the, like there's a flow chart that they will help you with. If you're like really savvy on the internet, you can probably find the, flow yourself. Or also pharmacists tend to be able to help with this question. So it really depends like when it was, and like what, what's the context? Was there unprotected sex in the last five days?'cause that's how long sperm can live. The problem with missing a pill is your pills are suppressing ovulation typically. And if you miss a pill, your body has a chance to ovulate. And then if there's still sperm in the reproductive tract, or sperm shows up in the reproductive tract, in the time when the egg is available, you could get pregnant. So if you miss a pill and you're like, well, I haven't had unprotected sex that, you know, it's not a huge deal, just remember to take your pill and then keep going. But there are some exceptions around when the pill is gonna be effective again. Oh,

Mathilde

Oh,

Claire

yeah. Like after you missed it. Yeah. Okay. So the most important pill of a pill pack is the first one.

Mathilde

Okay.

Claire

If you've taken that seven day break at the end of your last pack. So taking one pill a day for 21 days for three weeks, sort of like buys you a week of no pills or sugar pills where you're not gonna ovulate. It gets you seven days. It does not get you eight days.

Mathilde

Mm.

Claire

If you miss that first pill of a new pack, your pregnancy protection lapses. So not only could you ovulate, you are not protected again until you've taken a full week of pills.

Mathilde

I

Sabrina

did

Mathilde

did not

Claire

I do not know that. Isn't that wild? Yeah. That is so interesting. Yeah. Wow. And people should know that. People should know that.

Mathilde

yes. Yeah. I

Claire

I feel like, yeah. I thought if I miss a pill, I just take two the next day and just don't think about it that much. I mean, sometimes that's fine, like it's very context specific. But if it's the first pill of the next pack, I don't consider you protected from pregnancy by that pill pack. Unless you've had one pill every day for seven days.

Mathilde

Mm.

Claire

Wow. Now here's a cheat for it. So you get, you have your 21 pills, three weeks of pills, and then you have your seven days. It gets you seven days. If you are somebody who might forget that first pill, the next pack, you can shorten your in hormone free interval. The sugar pill week to like four or five days. And then if you forget, you're actually only at six days. So you have a little bit of wiggle room. Nothing has elapsed. Your pregnancy protection hasn't lapsed. You get seven days, you don't get eight. Well, well, and do you have any recommendations to help people remember? I really do pill long time. I really do. Okay. There's a free app. They're not paying me. There's a free app called Medisafe and it is, I speak from professional and personal experience. It's an app that is so helpful for remembering daily pills. It like makes your phone yell at you until you take your pill. Until you've told your phone. You took your pill and you can snooze it and you can like set different times and you can also program it so it texts a med friend. Like a partner or a sister, whoever text someone, it'll text someone and be like, this person didn't take their meds. Go bother them. I love it. I'm obsessed. That's hilarious.

Mathilde

fun.

Claire

So you can pick your partner and then your person will tell you, take your Yeah. Way to offset

Mathilde

on,

Claire

need. Yeah. Offset some of that labor. Yeah. yeah. Med safe. Y'all download that.

Mathilde

Fantastic.

Claire

Fantastic. I also just wanna say, if you're somebody who has a hard time remembering to take a daily pill, even if it's a really important pill, like contraception might be to you, welcome to the rest of the, like everybody's in that same boat. It is just truly a hard thing to do. And it's not like a moral failing. It's not like a cognitive failing, it's just difficult. So some people like really beat themselves up about this and I'm like, no, this is standard. Like we know that this is hard and if you're sick of it, we can talk about a less labor intensive birth control method. Mm-hmm. Okay. Yeah. And you talked about.

Mathilde

about

Claire

The estrogen and progestin pill that you have more time to take it. Like a 24 hour Yes. Period. Yeah. So a missed pill when you're taking a combined contraceptive pill is, you've missed it by more than 24 hours. You were supposed to take it at 9:00 PM on Monday. You didn't take it until 10:00 PM Tuesday. That's so interesting.'cause I feel like when I originally started on oral contraceptive mm-hmm.

Mathilde

My

Claire

Clinic physician told me to, if I miss one, wait and take it with the one after that? Yeah. Is that not what is recommended anyway? Well, it, again, it depends where you are in the, like how long you've missed it for and what, what week you're in. But yeah, so you might be taking two at the same time. So if like you didn't take it on Monday night and you remember on Tuesday, you probably are gonna take two. But if you remember before that, just take it. Yeah, take it when you remember. Okay. Yeah. Okay. Again, you need to accumulate those 21 pills, 21 days mm-hmm. To get your seven day break. And then that's also true of the sperone sperone progestin only pill. You get that 24 hours. Right? Mm-hmm. Now, I wanna be really clear.

Sabrina

If

Claire

wanna maximize the effectiveness of your pill, take it around the same time every day, right? Like, don't push it with the, that 24 hour wiggle room. But when we're talking about missed pill guidelines, like what to do and how to minimize risk when you've missed a pill, that's our definition is you've missed it by 24 hours or more, Okay? okay? Mm-hmm. So when you realize you missed it, you just take it, take it, it, okay. Clear. Clear as day. Okay. We have a couple questions that were directly submitted from our audience about the pill for you now. Yes. So the first one is, how long does it take for your body to regulate and regulate? I think could mean a lot of different things. Mm-hmm. Context of this, let's say like your periods to become mm-hmm. Normal again after off of off of the pill. Yeah. Yeah. So there's a few different answers to this. The first one is, if you're wondering when you could get pregnant after stopping the pill, it could be in the, in like the 24 hours after a missed pill. Like if you miss the first pill of a pack, right, right away you can ovulating and get pregnant right away when it's, when we're talking about like, how long will it take for my periods to become regular if they ever have been or ever will be regular so that I can track ovulation to try to get pregnant. Typically, we're talking about two or three cycles. If you're saying when will my body go back to baseline? Maybe a little bit longer than that, but usually we're talking about two or three cycles. Mm-hmm. Okay.

Sabrina

Okay.

Claire

I don't know if that makes sense.

Mathilde

online,

Claire

there's a lot of things about, um, the like getting off birth control syndrome or something. I don't know what that means because it's not a, a, a syndrome based in evidence. Okay. But like the, the feeling of coming off birth control, I'm not saying it doesn't affect you. Of course, of course. You're gonna have, and I tell people this, like part of informed consent is not just starting birth control, but discontinuing it. So if people are like, I really want my hormonal IUD out, I say, great, please expect your menstrual period to get heavier. Mm-hmm.

Mathilde

Okay. Because

Claire

Okay.'cause I think what we've been seeing online is like the fear of like, oh, you've been on your birth control pill for maybe 10 or 15 years. Yeah. And then when you get off, you don't know what it's gonna be. Like, what are people saying? Happens? Acne. Like your period never comes back. Yeah.

Sabrina

Yeah, I

Mathilde

Lots

Claire

of misinformation, intolerance, interesting. Um, I mean, acne makes sense because birth control, like estrogen based birth control does. Treat acne. So if we're removing a treatment that makes sense, The rest of it, I'm not sure is based in evidence, but it's not that I don't believe people's experience. I have heard the thing of like you get off birth control and then all of a sudden you're like attracted to different people. Yes. That I don't think has any evidence backing it up yeah. Yeah. Okay. Another question from our audience is coming back to the miss, um, birth control pill. So this person says, I,

Mathilde

if I miss one control pill, and I take two the next day mm-hmm. I start spotting. Mm-hmm. And then I spot until I get my actual, like the bleeding Yeah. The period after. And they're wondering if it's normal. It's a, it's a known sort of side effect, potential. side effect of missing a pill or like not taking it consistently. That said, even if someone does take it consistently and they have spotting, it could still be from the pill. Um, but yeah, that makes sense to me. It's not like dangerous. Okay. Or like a, a red flag that we would have to pursue. Okay.

Sabrina

Okay.

Claire

Um, certainly if someone like really consistently had bothersome spotting or we didn't have a good explanation for why they're bleeding, yes. I want them to be seen and, and that to be investigated, but yeah, that makes sense to me. And could that person come in for counseling? Yeah, of course. And potentially be put on a different pill or something? Yeah. I mean, if the issue, if it's never happened before and it's just like I missed a pill, I took two at the same time, and then I have spotting, like if it's a one off, I'm not that fussed, but if it's like a consistent thing that's happening or if the issue is actually that they're missing so many pills right. Then maybe we talk about.

Mathilde

about,

Claire

You know, other options. Um, yeah, I mean, I, I'm, so, I'm just always open to troubleshoot these things. Right.

Sabrina

Mm-hmm.

Claire

Which is the right way to be. Come on down to options. Yes.

Mathilde

Yes.

Claire

Um, another listener wrote in that she tried the pill and felt extremely emotional.

Mathilde

and even

Claire

Mm. Suicidal. She tried six different pills. Is there any known association between birth control pills and depression? So mood changes are a known side effect of hormonal birth control. It doesn't happen for everybody. It happens for some people for sure. And it can go in either direction. So some people do feel much worse than their mental health on the birth control pill. And the opposite is also true for

Mathilde

for

Claire

some people. They're like, I now I don't get depressed, or My anxiety is much better, or whatever it is. So if somebody is coming to me and they're like, I'm having this side effect from birth control pills, I just believe them.

Sabrina

And

Claire

And also I just wanna say to that person. Trying six different pills, like you really gave it a try, like a really good try. And I think that that's trying a medical, any medical intervention that doesn't have a 100% guarantee of success, which is all of them, is a vulnerable, and I think also loving thing to do for yourself. Like I actually think that's very brave and so

Sabrina

good

Claire

for you. If it were my client, I don't know that we would've gotten to six. I think we would've given up earlier than that, but that's okay. And yeah, I believe them that that's their side effect. And for somebody who had a side effect that got to the point of suicidal ideation, I would actually call that like an adverse effect from a medication and I would really hesitate to put them back on that medicine. So I think it's actually important to tell your provider, this is what I experienced on this medication, so that we can take that information. Like if you had had a terrible allergic reaction to another medication, like we would wanna know. You, I would want you to tell me, so I, that's true about birth control as well.

Sabrina

Yeah.

Mathilde

Okay.

Claire

So we could talk about the pill for hours. Yeah. Oh, I know. Oh my God, we, so, yeah. There's just so many questions. Okay. Wait, I have one more. Yeah, please, please, please. It's just how long is it recommended to take the pill? Like is there a time limit, like after 10 years, you've gotta get off of it. No.

Sabrina

Okay.

Claire

Okay. So you can be on the pill for as long as it's working for you and as long as you're happy with it. The thing that changes is people's medical picture changes with h and so we do wanna check in with people whenever we're renewing that birth control prescription to make sure has anything changed? Are there any medical contraindications that have come up that would be a good enough reason for you to stop taking the pill? But it's safe. No evidence that it affects future fertility. So often when we see birth control pills in the news, or there's backlash about them, it has to do with blood clot risk. And I just wanna be very clear. In general, these pills are very safe. People who are at elevated risk of dangerous blood clots, we don't tend to put them on the birth control pill with estrogen in it. The underlying risk of blood clot, like a dangerous blood clot, is quite low. And it is true that the combined hormonal contraceptive pill increases that risk of dangerous blood clots four or five fold. Which sounds scary, right? But if I said to you, I'm gonna give you some money and I'm gonna give you four or five times more money than you get, what's your first question?

Mathilde

How

Claire

much money? Yeah. How much money are we talking about? Right? Because if I, I'm giving you a quarter, then you're getting a dollar. Yeah, that

Mathilde

sucks. And

Claire

that's, and like that's not enough to buy a bag of chips. So what are we

Mathilde

are we

Claire

talking about? We're talking about actually very low levels of risk. And then also we need to compare being on birth control to the alternative. So certainly like not being on birth control is slightly lower risk for dangerous blood clots. But getting pregnant or the three months after having a baby, the blood clot risk is astronomically higher than being on birth control. So we're actually probably by putting people on birth control pills, reducing the overall level of blood clot'cause we're preventing pregnancy. That's super interesting. Yeah, I think that's a great comparison to me. You know, that.

Mathilde

that. Yeah. Yeah. Okay.

Claire

Thank you for talking about that. You're very welcome. Okay. So now we'll move on to the vag1nal ring. So it's similar mm-hmm. Effectiveness as the birth control pill. But I feel like we don't have to talk about it as much. Mm-hmm. I didn't know about this until like last year. Mm-hmm. Yeah.

Mathilde

I

Claire

know a few people that are on it, but even them, I don't think they know fully what it is. Mm-hmm. So could you you explain a little bit like how it works and, mm-hmm. Mm-hmm. So it's another combined hormonal contraceptive. So it has that estrogen piece, the ring, it's like a, plastic, like soft bendy material, and you kinda like fold it up and you put it inside the vagina. And, because it's sitting inside a mucus membrane. Vaginas are very absorptive, like they'll absorb whatever is there. So the hormone kind of leaches out into the mucus membrane and then through the bloodstream. Because of that, we are bypassing your GI tract. So like when you swallow a pill, your body has to metabolize that pill, through your GI tract. And so actually, the amount of hormone that we give to you is less than what ends up in the bloodstream.'cause your body's kind of getting rid of some of it. So one nice thing about the ring and the patch as well is we're bypassing the GI tract and so we can get away with less hormone. The other thing is if we're delivering estrogen right to the vaginal canal. We can actually treat a little bit of what we call a vaginal atrophy. So somebody has a low estrogen, maybe they're in perimenopause but they still want birth control. The estrogen from the vaginal ring can actually help treat some of that estrogen deficiency. People find that they have less dryness, less like fragile tissue. So that's a consideration. The other nice thing is you don't have to remember to do something every day. You put it in and you can leave it for three weeks and then you take it out again for that up to seven day period. You get seven days, you don't get eight. Yeah, people who love it love it. And then some people are like, I don't wanna have to put something in there. But I would say it's probably more comfortable than a tampon'cause it's made of like a, a material that kind of softens with the heat and moisture of your body. Okay.

Sabrina

Okay.

Claire

I was gonna ask you. can Do people feel it? it? Um, sometimes I would say if you can feel it and it's uncomfortable, it's similar to a tampon, like not far enough in past the pubic bone, you certainly don't have to take it out for sex. You can if you want to. As long as it's not out for more than three hours, you're okay.

Mathilde

Okay.

Claire

How is it working

Mathilde

compared to

Claire

the pill? Like, is it suppressing ovulation? Is it Yes. Making the cervix? Yeah. Because it's the combined hormonal contraceptive, it's suppressing ovulation. And it's also gonna do the, the work of making the cervical mucus thicker and then also thinning the endometrial lining. Okay. Mm-hmm. And is that true for all, like combined contraceptives? They're all doing the same thing. Just

Mathilde

you're

Claire

getting the hormones? Yes. We're delivering the hormones differently. Okay. Good to know. Mm-hmm. Okay. Does it ever fall out? Um.

Mathilde

Um,

Claire

Yeah, sure. Maybe, probably like, I'm sure it's happened,

Mathilde

Mm-hmm.

Claire

But if it's falling out, it's probably not in far enough. Or maybe you're having an issue around like prolapse that you should chat to somebody about. But I, I don't think that people tend to find that problem and you, if it falls out, you just put it back in. Yeah,

Sabrina

Yeah, that's

Mathilde

That's a

Claire

good point. Um, and then you mentioned you can take it out for not more than three hours. Yeah.

Mathilde

Yeah. Where

Claire

do you put it? What's, oh, I don't know. Like a dish or, okay. I don't know. It doesn't really matter. Okay. It doesn't like dry up and then No. And if it does, it just get re moistened when it goes back Yeah. Sweet.

Mathilde

Wow.

Claire

Sounds pretty good. What are the benefits or like common side effects? Um, so it's gonna be like a similar profile to the combined hormonal contraceptive pill. But like in theory less, like, less likely to have those side effects'cause we're not giving you the hormone orally.

Mathilde

Hmm. Okay. But usually

Claire

similar stuff. But that also means the acne benefit will be dialed down a little too. Right. So like side effects, which can be good and bad Yes. Will all be reduced. Yes. Intentionally. Yeah. Mm-hmm. Okay.

Sabrina

Okay.

Claire

Similarly, the patch, as we've just said. Mm-hmm. It's the same. Where does it go? It like what is the patch? Yeah. So the patch is not that popular, honestly, I think it's because it has a level of medical adhesive that sometimes gives people a rash and also it's easy to sweat it off. But like, if people like it, they like it. I actually forgot to look this up if it's covered by MSP, but when mSP initially started covering birth control pills. It wasn't covered

Mathilde

Mm-hmm.

Claire

or like birth control in general. It wasn't covered and neither was the ring. But then there was so much backlash about the ring.'cause people love their var ring when they love it, they love it. And they were like, why can't I have this covered? So anyway, now, the ring is covered. Yeah. And no one was like, oh, I love the patch.

Mathilde

so much.

Claire

I didn't hear the same uproar. I didn't hear anyone upset about the patch. But yeah, it's like, like a sticker. You put it on your body, you replace it. I think it's every, every week. I've truly never started someone on the patch or seen someone on the patch. That's how, like in my practice, it's how rare it is. But you can put it anywhere on your body. No, absolutely not. So places you're allowed to put the patch, your stomach, your buttocks area, your upper arm. Most places on your upper body, you're just not allowed to put it like on a breast. Okay.

Sabrina

Okay?

Claire

I think people are worried about if you did happen to have an hormone sensitive cancer, right? Mm-hmm. We don't wanna

Mathilde

put

Claire

a patch right there. Yeah, that makes sense. Yeah well then we can move on to

Mathilde

the

Claire

the injection, which I've never heard of

Mathilde

before.

Sabrina

Really? You've

Claire

never heard of it? Have you ever heard of it as Depo or Depo Provera? I have. Okay.

Mathilde

I have not.

Claire

Okay. So Depo gets a bad.

Mathilde

rap

Claire

And it's partially fair and partially not. I'm here to clear depo's name. So

Mathilde

Depo-Provera

Claire

is just like a quite a large dose of progestin, and we inject it either subcutaneously, so like in the fat that's between muscle and skin or intramuscularly.

Mathilde

intramuscularly.

Claire

And it works about the same in either place and it works for a long time. So it's nice that you don't have to think about it. It's annoying that you have to like go somewhere for an injection in some parts of the world. And even Canada, like if you work with your provider, you can set this up. Some people inject it themselves. Um, and it works for 15 weeks, not 15 weeks. In one day though, really, ideally we're doing it every 11 to 12 weeks. But if you come to me and you're like, it's been 14 weeks and six days, I'm like, oh, I'm not that worried. People who love it, love it and it's also. After the Morena, IUD, it's probably our next most powerful way to suppress menstruation completely. So if people are, are like, I really don't want a period, my first choice for them is the Morena IUD. But after that, if they're willing to try Depo, sure. Like, I think that's reasonable. The trouble with Depo is we're injecting it and then it's gonna work for 15 weeks, but then the time to return of fertility or a regular menstrual period can be even longer than that. So if somebody hates it, I can't get the medicine back out of them. Right?

Sabrina

Right?

Claire

Like if somebody came into my clinic two weeks after an IUD insertion and said, let's turn this around. I don't want this at all. I can take it out. And within a cycle or two, they're back to their baseline. But with Depo, I can't, they just have to write out those side effects. For 15 weeks.

Sabrina

Okay.

Mathilde

Okay.

Claire

So that's the downside of Depo. But the upside of Depo is we're pretty reliably suppressing revelation. We're suppressing menstruation in a big way and some people just feel so much better on it. Oh, so it's a good option for some people.

Mathilde

Yeah.

Claire

Yeah. I say like, don't knock it till you try it. It's not probably gonna be the first thing that your provider suggests for you. I'll also say, so it's like, you know, can be a bit sad to think about, but for some people it consideration is they wanna use birth control, but they can't tell the people in their life that they're using it'cause it's not safe to share with Depo. There's truly no evidence that you have it, and it. works pretty long term. compared to something like the pill where you have to hide the pill, you have to take it every day. What if you don't have access? and then also with Depo, like we find that people who have precarious lives or, a trauma history that would preclude them from getting an IUD for example, or preclude them from taking a daily pill. If that, if that's just too difficult, depo tends to be a good option for those populations.

Mathilde

Okay.

Claire

to think about.

Mathilde

Okay. No, that's

Claire

No, that's good to know about. Mm-hmm.

Mathilde

where

Claire

do you go with like, let's say our,

Mathilde

listeners,

Claire

yeah.

Mathilde

oh,

Claire

Oh, I want this, Um, you can come to my clinic. So, so a lot of the community health centers, youth clinics have it on hand. You can in theory like fill the prescription at any pharmacy and then if one of the pharmacists at that pharmacy does injections, they can do it.

Mathilde

Mm-hmm.

Claire

If your provider is willing to train you to do your own injection, you can do it. Those are a little bit harder to arrange. I think the pharmacy injection fee is like$10 or something but sometimes you have to pay for that. Anyway, a few options. Okay. That's super interesting.

Mathilde

I

Claire

I actually didn't know anything

Mathilde

about

Claire

the injection. Yeah. Yeah. Either. The other interesting thing about Depo is there are some forms of epilepsy that are triggered by the menstrual period and we actually give people Depo or, this wouldn't be me in my practice, but a specialist would prescribe even higher doses than Depo to folks and it can be a, an epilepsy treatment. Isn't that wild? Yeah. Yeah. I've also had clients who have PMDD who cannot take estrogen for whatever medical reason.

Mathilde

Mm-hmm.

Claire

And we've tried Depo and it's worked like a dream. Sounds like.

Mathilde

like

Claire

Often not gonna be a first line, no option, but like a great thing to have in the back pocket.

Mathilde

to

Claire

Yeah. For people. Yeah. Yeah, yeah. We like to keep it as a, an option. Preserve it as an option. Beautiful. Okay, so now we'll move on to the next class of contraceptive. So these ones are the most effective methods for preventing pregnancy.

Mathilde

So

Claire

they include the famous IUDI feel that we have a lot of questions about this one. Then there's also the implant and sterilization. With fewer than one in a hundred people using these methods, getting pregnant every year.

Sabrina

So

Claire

Mm-hmm. Very effective. So let's start with the IUD. So the intro UR device. Mm-hmm. So

Mathilde

first

Claire

off, what is A IUD and how does it work in the body? Okay, so it's a little T-shaped device. I cannot believe I didn't bring one. Anyway, you can Google it. Uh, I'm actually sure that most people know what an IUD looks like at this point. But it's a little T-shaped device and, it sits inside the uterus and it prevents pregnancy in different ways based on if it's a copper or a hormonal IUD. So the copper, IUD um, copper is a spermicide. It really just kills the, and confuses them like they swim in circles. Um, yeah.

Sabrina

not very

Claire

Smart. Yeah. They're not,

Mathilde

their

Claire

their, their power is being in, in high numbers, not in being like smart individuals. Um, and then the, hormonal IUD, it's thickening the, the cervical mucus and thinning the endometrial lining.

Sabrina

Okay.

Claire

Yeah. And not suppressing on the,

Mathilde

culation,

Claire

not reliably, it's still possible. Okay. But not in a way that we can attribute the effectiveness of the birth control to. Okay. Yeah. So that's, if that makes sense, how you describe it as it's function. Yes. Sometimes it will. Yes, for sure. Okay, Good clarification. And what are the benefits of the copper versus the hormonal

Mathilde

IUD?

Claire

ID? So the, the main difference between the copper ID and the hormonal IUD is the effect on your menstrual period. So the copper ID is going to make periods heavier and the hormonal ID is gonna make them lighter. The other nice thing about the copper ID is, you know, it's not all bad with the copper IUD, you're totally bypassing the possibility of hormonal side effects. So for some people that's really important. And if somebody comes to me and they already have a light period and they say, you know, if this period gets 20 to 60% heavier, I can live with that. And some people like their period gets heavier or a little bit longer and they barely notice. Great. That's, I think that's a great outcome. But for some people, they come back to me and they're like, this. Is untenable. I can't do this. But yeah, copper, IED great for a lot of folks. And then the hormonal IUD is truly, not only is it an incredibly effective form of birth control, it is such a powerful tool to suppress menstruation. So with the Mirena, we have a really good shot. It's really my, my best tool in my toolkit at giving you no period or very, very light period. The downside is you might have those hormonal side effects and also, the first three to six months, you might have some unpredictable bleeding, I would say. So if you're somebody who like. I can't tolerate that, then maybe that's not what I'm gonna suggest. The other downside to both IUDs, I will say is the insertion process, which we can talk more about. I'd like to debunk some things and make people feel maybe, hopefully more confident about it. But, certainly there are lots of folks who will not consider an IUD because of what they have heard the IUD insertion, process to be like, or their previous experiences

Mathilde

mm-hmm.

Claire

That. Okay. Going back to what you said a a little bit earlier, some people can fully suppress their period. Mm-hmm.

Mathilde

With,

Claire

Um, the IUD, is that in any way unhealthy? No. So it's safe not to ovulate and not to have a period for long periods of time. If, if that's happening, and we don't know why, I would want someone to have that investigated, but if we know that, like if this is a known side effect of a form of birth control to stop having a period. That's fine, that's safe. So I know that there's a lot of fear mongering online about, well what if you take the pill for 10 years and then you stop and you never get your period back? It's not that that's never happened, it's just that it's extremely rare and then you do medical follow up and you figure it out. It's not a common thing to worry about. On a population level. We don't see reduced fertility from long-term hormonal contraceptive use. What we do see is that aging reduces fertility. We haven't figured our way around that yet. Mm-hmm. And there's a lot of people that are starting the IED and they love it. They don't have their period. For like

Mathilde

like

Claire

years. Mm-hmm. And then after like year two or year three, they start having their periods again. Yeah. Is that normal or like what? Explain that. Yeah, so the amount of hormone in the IUD that's being released is going to slowly dip over the however many years you have it. So with the Kalina we're talking about, three to five years. So basically, on the box it says three years, but we've studied it up to five and it's a, it's just as effective for birth control up to five years. But we do find that people between that three and five year time frame are going to get spotting. It's quite common for the Mirena. You can use it for up to eight years as really effective birth control. But again, the further you get into that eight years, the more likely it is to have your period come back or have some spotting or have heavier bleeding. And so I do say to people, just because we know this works for contraception for eight years. If you're unhappy with your bleeds at year five, come back. Mm-hmm. Or even sooner. Like we can even have a conversation about it. For people with really, really heavy periods. If, we find that switching a brain out every three years for them is what works great. Mm-hmm. Okay. You know, I'm fine with that. And for someone that's not sure if they wanna get pregnant,'cause I know, we're at that age now, like it's like in mid twenties, you're not sure if you wanna have kids mm-hmm. In the next five or eight years. Mm-hmm.

Mathilde

'cause

Claire

It's like a big, like, long term commitment for this. ID So would you recommend it even if they're like, oh, I might have kids

Mathilde

in

Claire

for three years or two years, I'm,

Mathilde

I'm,

Claire

I'm fine with that. Okay. Truly, like you could make an argument like, oh, you know, the resources if like it's a$400 ID and you're only gonna use it for a year, is that really worth it? I think that when a birth control works really well for somebody, the benefit is not quantifiable. Mm-hmm. So I'm fine with that. Although they do have to consider that they have to come back in to get it

Mathilde

out,

Claire

out, whereas like another birth, birth control, you just stop. So I guess it just depends how soon. Yes, for sure. Like if you said to me, in three months, I'm gonna try to conceive, I want an IUD today, I'd be like, okay. But you're gonna have probably some unpredictable bleeding and then you're gonna come back and then you probably need a couple cycles to track your ovulation. Like, are you sure that this is,

Mathilde

mm-hmm.

Claire

I still wouldn't say no, probably honestly, if people were really sad on it. I want people to think of it as like a long-term potential benefit. Like, if you go through the IUD insertion process, you might get eight glorious sears of highly effective birth control and, you know, maybe even no periods. But you are not locked in, it's not a mortgage. Like you can, if you come to me at any point in the eight year potential lifespan of the marina and you want it out, I will take it out and I will say, I don't recommend this officially, but in the COVID, when people wanted their IUDs out,'cause they're like, I'm not doing anything. I might as well have a baby. And they wanted their IUDs out and we weren't seeing people in. Person. There was, from one of the main sexual health organizations, a info sheet about how to take your own IUD out. If you're just using your own fingers, trying to feel the strings, grab the strings and take it out, like it's very, very difficult to hurt yourself.

Sabrina

Huh.

Claire

The main. Risk is that you don't get the whole IUD out and you don't realize that and then you're like, why can't I get pregnant or mm-hmm. You know? So we don't recommend it, but I guess we don't recommend it. But if part of why you're not considering an IUD is you're like, I will be stuck and I'll be reliant on somebody else to take this out of my body. Let me tell you, people accidentally take their IUDs out because they think that they forgot a tampon in there. And they like just pop it out on a glass of chardonnay, like all the time. Like if you wanna try to take it out yourself and that knowing that that's an option is psychologically soothing to you have at her.

Mathilde

Okay.

Claire

If people accidentally do it, I'm like almost never worried. I just, ideally you keep it and. You send a photo of it to your family doctor or your nurse practitioner and be like, is this the whole thing? Did I get the whole thing? Okay. Super interesting. Okay, we have a couple of questions directly from our audience about IUDs. The first one is, why don't we provide more pain management for inserting IUDs? I think that's a main barrier for a lot of people to get it. Yeah, for sure. The answer to this could be a thesis. So I mean, is it partially misogyny? Yes, for sure. Like the healthcare system hasn't cared enough about folks with uterus and their like comfort health, et cetera, et cetera, since time immemorial. And also it's more complicated than that. So like we're not just being assholes. The system's not just being unfair. There is a few things going on. Part of it is some people aren't trained to do the pain management. We need to fix that. I was trained to do the pain management, and in my practice, if I was in a situation where I wasn't supported by the clinic with the right supplies, I just wouldn't regularly offer IUDs. Like for me, offering IUDs means I can offer various tiers of pain management. Part of it is red tape, so there's a new IUD pain management option called Penthrox, which is like a whistle and you inhale laughing gas essentially. But it's very, very hard to do that in a healthcare context. Because there's a lot of regulation around what supports you need to manage an emergency in that case. So there's red tape, meaning we can't offer that in lots of outpatient settings.

Sabrina

Okay.

Claire

Okay. Sorry. So you inhale lasting. Yeah. Yeah. So you just.

Mathilde

laugh.

Claire

Well, we call it laughing gas. have you ever seen someone like break their leg and the ambulance comes and they give them a little whistle and they like inhale it? I've also heard of people getting this with their IUD. Yeah, yeah, yeah, yeah.

Sabrina

Oh,

Claire

And in the moment, it's interesting, it's interesting when people use this because in the moment, like they are clearly still in pain, but they don't tend to remember, like, you don't register the memory of it. Yeah.

Mathilde

Mm. And

Claire

My, my friend who had this done said she felt like she knew there was pain. Yeah. It wasn't her pain. Yeah.

Mathilde

Mm.

Claire

Which is great.

Mathilde

great.

Claire

We, we give similar sedation for like when people break their leg and that we're transporting them somewhere, or like, even when they're getting their tonsils out, like it just makes you not care. Hmm. Yeah. But then in outpatient clinics, it's hard to get. Yeah. Most people are not set up to be able to do that according to the. Regulations. Mm-hmm. Okay.

Mathilde

Okay.

Sabrina

Would

Claire

you say it's getting better in general about how I like to, it's being offered. I like to think so. Yeah. But even if we can't do pent rocks, we can do a cervical block. I think everyone should be offering a cervical block. So let me, lemme break it down. Okay. The things that hurt with an IUD insertion, putting the speculum in shouldn't hurt. If it's hurting, something needs to change in the practice. Now some people absolutely have pelvic pain and all speculum, insertions are gonna hurt for them. I'm not, I'm not talking about them. I'm talking about the average person who doesn't have a chronic pain condition, affecting the vulva. So the speculum insertion,

Mathilde

Yeah,

Claire

the practitioner should be really good at this and be able to place it without pain. We have to clean the surface of the cervix, and that's probably gonna be about as painful as a pap smear. And it also has to do with like. You know, the rapport with the, between the client and the practitioner and how good that practitioner is at doing this. The other thing that hurts is putting what's called a tenaculum on the cervix. So most uterus are sort of flipped forward on top of the bladder, and then you have your cervix kind of here. And so we need to put a clamp on the cervix to kind of pull the uterus straight so that we can measure the length of the uterus and then insert it. The tenaculum is like a clamp that we have to put on the cervix. It hurts to put it on for sure. That's what the cervical block is for. The cervical block is like getting lidocaine at the dentist. You're not frozen when you get the needle, so you feel the needle. So some people find the cervical block itself painful. So then what do we do about that? Well, we can put like at the dentist some topical lidocaine on the cervix to help with the pain of that. The evidence for that isn't great. When we study it, people don't find that it helps very much with the pain of the cervical block. But I don't know, anecdotally I find that it's a good option and some people really benefit from it. So that's, these are sort of my layers of, we could do a topical, we could do a cervical block, and then that helps with the tenaculum pain and it also tends to help a little bit with the pain of the insertion itself. But when we insert an IUD, the uterus needs to cramp when we measure, yeah. Right. Remember the.

Sabrina

the,

Claire

For me when I got one was the measurement. Yes. Yes.

Mathilde

a lot.

Claire

So we're not doing this just for fun. Like we need to measure the length of the uterus so that we put the IUD in far enough that it's effective.'cause if it's not in far enough, it can reduce the effectiveness. And I wish we all had the same size uterus, but we do not. So we need to figure out how many centimeters are we talking about. And when we're measuring the uterus, we go right up to what's called the fundus, which is like the top of the uterus. And when we touch that part, it cramps and it's supposed to.

Mathilde

And

Claire

it's, we can't really fully get around that. Like even if we could fully stop it from cramping, I don't know that we'd want to because the cramping also prevents too much bleeding, right?'cause we're disrupting the endometrial lining and we want it to stop bleeding. And compression of cramping helps with that. So should we be doing better with pain management with IUDs? Yes. Can we eliminate pain completely without completely like sedating you? No. But in my experience, when I set out the menu of options, and the one thing I forgot is Tylenol, ibuprofen, ibuprofen's, more important. But I say, we're building a house of pain management. We're starting with the foundation. That foundation is Tylenol and ibuprofen.

Mathilde

Then I

Claire

set out a menu. I'm like, okay, what of these pain management options are we doing for you today? I think that the process of sitting with someone and they're acknowledging, I care about your pain, you get a choice in this and you can stop or pause the procedure at any time, is in and of itself a pain management strategy.

Mathilde

Mm-hmm.

Claire

I totally agree. I feel like if people go in blind and then they're just shocked by something that's happening that they haven't been explained at all, it's so much more painful and scary.

Mathilde

And

Claire

And then, then if they find out that there was other things we could have tried.

Mathilde

Mm-hmm.

Claire

Like even, even if we build a great pain management house. We're doing ibuprofen Tylenol, we're gonna do the topical, we're gonna do the cervical block, we're gonna do, you know, Penthrox. And then somebody has a terrible time with their IUD. In my experience, people are like, well then that is what it is. That was what it was. We tried, you were on my team, we got through this together. Yes, it sucked. But I don't feel like I was abandoned or deceived or that my experience of this didn't matter. Yeah. Anyway,

Mathilde

Wow. I

Claire

get off my soapbox now. I liked how you explained the steps. Mm-hmm. Because I think that's reassuring probably to a lot of people that mm-hmm. Don't know exactly what it is, what

Mathilde

is

Claire

gonna happen, and they just get there and then they get contraction and it's hurting so, so much

Mathilde

So it's good to

Claire

and understanding what's no, like what is going on. Mm-hmm. What this person is doing. Mm-hmm. And

Mathilde

And

Claire

fact,

Sabrina

that

Mathilde

it's normal.

Claire

important. Do I have folks who like to just put their headphones on and like zone out and they're like, don't talk to me, just do it. Let me know when it's done. Yes. And that is their right to do that, but the vast majority of people want to know what's going on. Mm-hmm. And what they can expect to feel next, even if what they can expect to feel next is painful. Yeah. We call it verbal lidocaine sometimes, or verbal analgesia.

Mathilde

Yeah.

Claire

Um, of just the, okay. The next thing you're gonna feel is this. Mm-hmm. And Okay, big cramp coming.

Sabrina

Yeah.

Claire

And take a few deep breaths and like it helps people get through.

Mathilde

Mm-hmm.

Claire

'cause it feels like, okay, we are a team, we are doing this together. The person getting the IUD has a much harder job, to be fair, but sometimes I think about it as I am the pilot of this medical encounter, but that person chartered the plane and I will not fly it into a storm. I'm not gonna do anything. Unsafe. Even if you want me to to like, I'll say no. But if they change their mind about what we're doing, where we're going, I will respond.

Mathilde

Mm-hmm.

Claire

They chartered that plane. I'm their pilot analogy. Yeah, that's great. That's really good. Okay, final question on IUDs from our audience was are there any cons? They seem,

Mathilde

pretty great.

Claire

Well, I mean if you, TikTok would love to tell you about all the cons, right? Like about how it's so painful and you know that they'll find the, like there are risks with every medical procedure. Is it possible to perforate the uterine lining? Yes. Can we just talk about perforation for a minute? So, most of the time when we're talking about uterine perforation, it means one of the arms of the IUD'cause I'm a T I'm in little IUD right now. Mm-hmm. Pokes into the wall of the uterus and it kind of just kind of gets stuck there. All we do is remove the IUD and then we can wait six to eight weeks and then we can try again if you want another IUD. Now, is it possible to have a perforation where the IUD fully gets passed through the uterus and then floats around and we find like, are there case studies of us finding IUDs in various parts of people's body? Sure. Like on a population level with the Millions of IUDs that have been done, all manner of awful things have happened. Sure. The risk is so incredibly low, and again, we're always comparing the risk of one thing to the risk of the alternative.

Mathilde

Yeah.

Claire

And the risk of the alternative is often getting pregnant and not to put anyone off of pregnancy, but pregnancy is dangerous, is a much more dangerous thing for a body to go through than an IUD.

Mathilde

Okay.

Claire

Okay. Moving on

Mathilde

to,

Claire

to the

Mathilde

implant.

Claire

which I feel like in Canada isn't the most popular mm-hmm.

Mathilde

I've heard in

Claire

In Europe is super popular. Yeah. Yeah. Yeah. Well, Europe and, um, the US had the implant way before we did. Um, health Canada really dragged its tails on approving it.

Sabrina

Mm-hmm.

Mathilde

Um,

Claire

it's the most effective form of birth control in Canada. More than a vasectomy, more than a tubal ligation like sterilization.

Sabrina

Wow.

Claire

Wow,

Mathilde

Wow.

Claire

isn't that wild? The body finds a way. It's upsetting. Yeah. That you can like, go through an entire tubal ligation and still get pregnant. Yeah. But okay, it happens. Why do people don't have it? Like what This, people often don't know about it. Okay. And that's, I think the main thing. So the implant is, it's about the size of a matchstick. It's made of a plastic that, when we insert it under the skin of the arm, the body kind of leeches hormone out of it. And one of the reasons why it's so effective is you can't just lose it. Like your uterus isn't gonna expel it like it can with an IUD again, rare, but it happens. And you are always able to feel where it is. So you can always say like, oh, it's not gone anywhere. It's never just gonna pop out of your arm. Can it move in your arm? So it has ever happened that this complication has arisen. But mostly, no, it just stays where we put it. Okay. So the body and its infinite wisdom, like mostly a body is trying to get rid of a foreign object, right? But if it can't, like with the implant, it'll just put little bits of scar tissue to keep it in one place. So that's usually just stays where we put it once upon a time. I don't know that we've ever had this happen in Canada, but once upon a time we would put the implant in a different part of the arm. So right now we put it kind of quite low. Um, but we used to put it between the muscles of the arm here,

Mathilde

And

Claire

some people were not good at insertions. They would put it so deeply that it would go into a blood vessel.

Mathilde

And,

Claire

Um, there were a handful of cases where it migrated, through the blood vessel, like into the harder lung. Yeah. Very, very dangerous. Very, very bad. Because that ever happened. We completely changed where we put the implant, so now we're putting it, away from any major blood vessels. And we, we also changed how we trained people to do it. So we're putting it in very, very shallow.

Mathilde

Mm.

Claire

And we say, when you have an implant, you should always be able to feel it under the skin of your arm. If ever you can't, you go to the doctor or a nurse practitioner and you get scanning done, to go find it. The other change that we made is we made the implant radio opaque, so it will show up bright white on all imaging. So it's really easy to find if it does buy great, but again, super rare. Mm-hmm. Super, super rare.

Mathilde

Mm. Okay. Okay.

Claire

And is this a progestin.

Mathilde

only?

Claire

Yes,

Mathilde

Okay. Yes. Mm.

Claire

So it's a really great option for people who just can't have the estrogen. Right.

Mathilde

Mm-hmm.

Claire

And are there any significant negative side effects for some people? Yes. So unfortunately, it's true of all birth control, but for some people they're gonna have no period at all, And they're thrilled for some people, they're gonna have spotting for weeks and weeks or months. These are the folks who come back to me and they're like, I can't, I can't do this anymore. Take it out. And if they want it out, like I take it out. It's, it's absolutely their choice. It. But there's a couple things we can do to sort of salvage the implant. So we can try a month of a birth control pill to try to kick their body into like a rhythm of bleeding instead of just spotting. We can also try non-steroidal anti-inflammatory drugs. It's a long, fancy name for, it's basically we do give them a higher than over the counter dose of Advil or Naproxen for a short period of time to try to settle that bleeding down. So if people are willing to try that, to try to salvage the implant, great. But if they just wanna know, that's fine as well. And then other people are gonna have like regular bleeds. Like it's, it's very hard to predict, but that tends to be the main reason that people get the implant out is that spotting. And how long do you have it in?

Mathilde

you have it in?

Claire

So on the box it says three years. We know it works up to five for pregnancy protection, when we like study populations who've had extended use, but it's like officially recommended for three. Okay.

Sabrina

Okay.

Claire

Okay.

Sabrina

Okay.

Claire

And then the other thing I've noticed is like, sometimes at three years people are getting their period back a little bit or their, their bleeding is a bit more unpredictable and they want to swap it out, which is fine. Okay. And is it like a surgery or how

Mathilde

how.

Claire

it's, it's

Mathilde

Invasive.

Claire

such a tiny little medical procedure. It's actually really fun to do. So, it comes in, uh, it's called an applicator. It's like this odd little device, where we like slide it in under the skin and then we pull a lever back and then it like leaves the kind of like a tampon inserter. It's Like, yeah. Or

Sabrina

sometimes I

Claire

I look at it and I'm like, this looks like a stapler, but it's not. We're not chunk. It's like,

Mathilde

oh.

Claire

Yeah, it's really, the applicator makes it actually quite an easy procedure. The experience of getting it in is less pain than an IUD

Mathilde

Mm-hmm.

Claire

I can numb the skin of the arm. So effectively, right? Like as we've talked about, I can't numb an entire uterus very well. I just can't, but I can numb the skin of your arm so that people don't even know that I've done the procedure. So you just feel pressure usually. Now that said, there's pain with the numbing, like going to the dentist, you feel the prick of the, the skin breaking when I, when I put the lidocaine in. But then you're, you're good and numb. Oh, mm-hmm. Great.

Sabrina

Perfect.

Claire

Okay, well let's move on to surgical sterile isolation. So basically what they're doing is they are, closing up the fallopian tubes, severing the fallopian tubes to prevent the egg from getting through to the uterus. It is a, a surgery, like a full surgery done under sedation. And so, there are definitely gonna be the risks of surgery with that. In the past, tubal ligation has been used for, good and evil, and also withheld for, for good and evil. So certainly there was what's called forced sterilization, particularly for indigenous folks or folks with developmental disabilities in Canada where they didn't want a tubal ligation or they maybe agreed to it under duress. And, this was done for racist eugenics purposes. There's also the issue of people who really want a tubal ligation who cannot access it because the surgeons, say, well, you might change your mind. You don't know what you want. You don't have any kids. You're gonna want them. Or you're too young or what have you. Now that we have the implant, I think the landscape has shifted a little bit. Like I actually, when I look at the risk of a surgery, I think, man, if you haven't tried the implant and we have no good reason that you can't tolerate hormones, it is more effective slightly and way less risk than tubal ligation or like even try it while you're on the wait list for a tubal ligation.'cause then if you love it and it works really well, then we don't have to do a surgery. But again, I think anybody who wants a surgery and is able to consent to it, should get it. Can you talk about the risk of the surgery? Yeah. So like anytime you're under general anesthesia, your anesthesiologist is responsible for keeping you alive because you're so sedated that you cannot keep yourself alive. So there's like always a risk. Now anesthesiologists are very good at this. So I don't want people to be afraid of general sedation, but it is just at baseline a much higher risk than if you're in my office and I'm putting a, Dinky little lidocaine in your arm, for example.

Mathilde

Yeah.

Claire

And then also they have to do an incision through various layers of tissue to do the procedure. Often it's done laparoscopically now. So we're not like slicing open the whole abdomen. Like it's not like a C-section. It can also be done at the time of a c-section if that's what somebody wants, but you need to plan ahead for that. Um. But it is still surgery, right? Like it's still a lot more tissue damage than other forms of birth control that are, some of them are no tissue damage. Okay. And so you can have your tubes tied. Yeah. There's also an option to just have your tubes removed. Yes. Yeah. That's sort of beyond my purview. Like, talk to your surgeon about your options. Okay. Because we have so many great contraceptive options that are less risk than a tubal ligation, I find that if somebody's gonna agree to an operation, we're offering, doing more things like if somebody wants a full hysterectomy, I think it's an easier case to make, right? Because tubal ligation isn't gonna fix, fibroids or like if it's a gender affirming hysterectomy. Tube obligation doesn't give us that. And so, yeah, I mean it's, it's really, you talk to your risk benefit about the each procedure with your surgeon, they make a decision. you book our time and then you wait a while for it.'cause it's technically an elective surgery. I will say sex sense keeps a list of surgeons who are willing to do tubal ligations. As long as people do like an informed consent process, no matter what their age or how many kids they have. There are just some surgeons who will entertain the idea and others who won't. So if you're really dead set on a tubal ligation

Mathilde

okay.

Claire

Call call to ask which doctor to get a referral to. Mm-hmm. It might

Sabrina

be

Mathilde

a

Claire

a good option for someone that doesn't wanna have kids. Yeah. People who know like right away, I really don't want kids. And I don't wanna have to deal with decades of birth control and

Mathilde

And

Claire

Like I just want a permanent option.

Mathilde

Yeah. And

Claire

and I'm willing to wait for a surgical date and like, you know, do the recovery and I'm tolerant of that risk. Sure. Great. Go for it. The other people who I, I see, really benefit from tubal ligations are people who are really fertile and they like keep getting pregnant despite their best efforts. For some people, like if they've had multiple birth control failures, and you know, they know that they're done having kids and sometimes we just get to that point where

Mathilde

Yeah. Yeah.

Claire

we're like, maybe this is our, our option. Mm-hmm.

Mathilde

Totally. Yeah.

Claire

Okay. Final questions from our audience, which are kind of all, about different types of birth control here.

Sabrina

What is the best option of birth control if you want to avoid systemic? hormones,

Claire

which we'll have to talk about. Mm-hmm.

Sabrina

And also avoid the pain of getting an, IUD

Mathilde

I

Claire

guess the first question, what does, what does it mean?

Sabrina

What does systemic hormones really mean?

Claire

Yeah. So to me, systemic hormones means the hormones are getting into your bloodstream and having

Mathilde

a,

Claire

an effect through your whole system. So hormonal side effects could affect any like system in your body so

Sabrina

even

Claire

though the IUD is working mostly locally, I would still argue that it has the potential for some systemic side effects. So I would say like all hormonal methods have the systemic side effects as a risk, I think I don't have enough information about this person's needs to recommend a specific method. Mm-hmm. Yeah. I think what I want. To make sure of when I'm talking to somebody about non-hormonal methods, like avoiding hormonal side effects, is, is this like a real or hypothetical concern? Like, have we confirmed that they have side effects and that they can't tolerate these hormones? Or is it hypothetical and is there misinformation there that we can debunk? But even if, even if they've decided like, I'm just not willing to take that risk. Okay, then let's talk about our non-hormonal options in order of most effective to least effective.'cause we're assuming that this person wants really effective birth control. Okay? Why are they afraid of an IUD insertion? Well, can we manage the pain? Are there options to make an IUD feasible for them? And then if they're saying, okay, no hormones, no, IUD, then we are left with these less effective methods and. If somebody's okay with that level of risk, then I'm certainly okay with it too. Mm-hmm. The other thing is I find it helpful to talk about, okay, what happens if you get pregnant? Like, is getting an ab*rtion an option for you? Certainly in BC it's legally an option financially. It's an option for people covered by MSP. Is it morally an option for them? That's an individual choice. Is it accessible to them? Like, is this somebody who works in rural, areas for six months at a time and it would be very hard for them to access an abortion or they do, they like live in Vancouver. These are very different things. So I'm happy to make a contingency plan based on worst case scenario if this less effective method fails. I think it's worth talking about, and it also can be very comforting for people to know, like a lot of people base their understanding of abortion access in Canada on US media, and it is just very different. So

Mathilde

so

Claire

I like talking through like people's fears and worries. Yeah. It's good to talk about it, to know that mm-hmm. This can happen. And if it does, there's ways that you can take and like it's, you're not left alone. Yeah.

Sabrina

Yeah.

Claire

I also fear that when they're choosing their contraceptive methods and thinking about effectiveness. Mm-hmm. They don't necessarily have that thought within them to be like, okay, if I was to get pregnant, yeah. How do I feel about that? Yeah. And that also is an important thought when you're deciding how effective you need to birth control to be. Yeah, totally. And I, I say this all the time to my clients. I say, if you or someone you know gets pregnant and they wanna know what their options are, just call sex sense, or certainly come back to the clinic, talk to me. But it might happen to you, but it is likely to happen to somebody, you know,

Mathilde

Mm-hmm. And

Claire

I really want most people to know and be able to communicate that abortion is one of the options when you're pregnant, like NBC. It's covered, safe, routine procedure, not without risk, but nothing is. And we don't have to live in fear of ever needing an abortion in bc, which is unfortunately not true about many places in the world.

Mathilde

Yeah.

Claire

Yeah, We have a few wrap up questions mm-hmm. For you. Mm-hmm. So the first one is, what advice would you give someone feeling overwhelmed so today we talked about all the con Contraceptive methods, and there's so many, and there's benefits to all of them. Mm-hmm. And then there's also risk. How would you tell someone like that's really overwhelmed? What would you say to them? First of all, relatable. It's true that there's so many options. It's, which is great. We love having options, but again, I think people. I feel so stressed about making an optimized decision about their health. They're like, I have to make the perfect decision and if anything goes wrong, it's my own fault and I should have made a better decision. And there's just a lot of pressure. So I would say well call sex sense. Talk through your options. Go visit your local sexual health nurse. We obviously wanna talk about this and can never shut up about it. And also let yourself off the hook a little bit about this decision. Like, I don't need you to make a perfect choice. I need you to take the information that you have. I will give you more information, and then we together will make the best choice we can with the information that we have.

Mathilde

Mm-hmm.

Claire

then again, we are still a team for whatever the consequences are.

Mathilde

Yeah.

Claire

So that's what I would say, and you can change your mind.

Mathilde

and

Claire

Try another one.

Mathilde

if you want.

Claire

Yeah. And just know that the stories you see on line are the anomalies or they're gonna be like the horror stories or like, this is the best thing ever in the world and you are statistically likely to fall somewhere in between. Gonna fall somewhere in between that spectrum of good and bad. And so don't let yourself be swayed by anecdotal evidence. But feel free to bring that anecdotal evidence to your healthcare provider so you can talk through it.'cause I think that like, it's silly to think that you're gonna make a perfectly like rational evidence-based decision That's unrealistic. I actually want you to bring your. Worries to me so that we can talk through them.

Sabrina

Yeah.

Claire

Yeah. And that we can honor them in silence and Yeah.

Mathilde

something.

Claire

And to be clear, if somebody came to me and they're like, I understand that it defies all logic and that there's no evidence for this, but the idea of having a device in my body, even if it's the most effective form of birth control available to me is just icky. And I can't handle it. That's a good enough reason for me to say, well, let's not do that. Mm-hmm. Yeah. There's no judgment there. I actually think that an embodied sense of comfort, or at least like neutrality about a birth control method is something that we need to strive for. I'm not gonna start you on a birth control that horrifies you. Mm-hmm. That's nobody wins. Like, I'm not doing that. Yeah. Okay. Another big question is what is one thing you wish more people. About contraception? Oh man. There's so many things. I think the main one is that like contraception is statistically safer than pregnancy. Again, pregnancy can be very worth it, right? High risk, high reward, but contraception actually find the risk reward ratio pretty good too. Like lower risk and pretty, pretty good reward.

Mathilde

Mm-hmm.

Sabrina

Yeah.

Claire

And also that it, this isn't a static thing like. You're allowed to change your mind about things. You're allowed to try different methods. I have people who come to me and they're like, I was on the pill when I was 14, and then I did an IUD, and then I went on the pill again, and now, you know, I hated IUDs at the time and I said I'd never do another one, but I'm actually kind of considering it and I Sure. Great. You're allowed to change your mind and also your medical picture and your medical needs will change over time. And so like do another consultation with your healthcare provider, that's totally reasonable. Yeah. And I find it interesting that you're comparing birth control, and all their like effects and risk that they have, and we're just talking about all the risk online, and it's just like overwhelming. Mm-hmm. So many risks, but it's true that there's risk associated with other things, like mm-hmm. Pregnancy and

Mathilde

not

Claire

being on birth control has a risk. Yeah. Yeah, exactly. But we don't talk about it that much. Yeah. Because you can't sue someone for not putting you on birth control when you never went to the clinic. Do you know what I mean? Like it's, yeah. It's easy to put the fault on

Mathilde

a medicine or

Claire

something. Yeah. But then people who don't go on birth control and get pregnant when they don't wanna be, they get blamed by society. Right. So it's just like, I think we all just need to be on a team where we try to get good outcomes and if it doesn't work out, we walk alongside each other to figure it out. Mm-hmm.

Mathilde

Absolutely. Yeah.

Claire

Okay. And last, before our

Sabrina

really,

Claire

Final, final question

Mathilde

We ask all of our

Claire

guests, are there any resources that you'd like to recommend to people who might be listening and have more questions? I mean, obviously sex Sense.

Sabrina

Mm-hmm.

Mathilde

I,

Claire

To be clear, what I love about Sex Sense is they have time for you in a way that as a clinician, I don't like, I, I really do try to have these conversations with my clients, but sometimes you need repetition. Sometimes you need like a bit more in depth and sometimes you're asking things that are nonmedical that I can't really get into. Sex Sense has time for you. Sex sense is options for Sexual Health's information and referral line. They're open Monday to Friday. 9:00 AM to 9:00 PM Someone please put the phone number in here. I don't have it memorized, which is a crime.

Mathilde

yeah.

Claire

Okay, great. It's staffed by registered nurses sexual health educators, like an incredible team. And they will talk to you about your thoughts and feelings about birth control. And then they'll also like provide you good evidence-based information. And I do just highly recommend them.

Mathilde

Yeah.

Claire

Yeah, I recommend your local sexual health clinic. I recommend youth clinics, especially the ones run by like health authorities. I like scarlett.com. That's one of my favorites. I like the Planned Parenthood website. Yeah, I mean, there's a bunch.

Mathilde

Okay,

Claire

well that's a good answer. Put them in the file for sure. Okay. Now our final question that we ask all of our interviewees. So the first final question is if you could bust one myth about women's health forever, what would it mean as a

Mathilde

I know it's a

Claire

really

Mathilde

big question. Hmm.

Sabrina

Mm-hmm.

Claire

I think it's that there's a snake oil on the internet, and by snake oil, I mean like an unproven supplement or device or something someone is trying to sell you on the internet that will solve whatever is going on with your body. And that if you just scroll far enough, you'll find it. And if you spend enough money on it, it will work. unfortunately. I understand more and more as I trained to become a nurse practitioner, that bodies will sometimes fail. They're sometimes difficult or painful to be in, and there are medical conditions that can be treated, but sometimes bodies are just uncomfortable or painful, and we have symptoms we can't solve every single thing. And that is a very vulnerable, difficult place to be in. And unfortunately, people will try to capitalize on that vulnerability and sell you something about it. Because

Mathilde

Because it

Claire

works, unfortunately. Yeah. It works for them, not for the client.

Mathilde

itself.

Claire

Yeah. Yeah. And they make a ton of money on, you know, an unregulated supplement. the other piece here is that people have started to equate natural with healthy. And I just wanna say like. Without any medical intervention at all. Even if we were eating perfectly organic, living whatever natural utopia people are talking about, people would still have PCOS, people would still have endometriosis, people would still have, hormonal symptoms that cannot maybe be answered by Western medicine maybe, but they also can't be answered by these natural remedies. Unfortunately, I can't speak to like anyone's specific case. Maybe they are gonna find solutions in natural remedies. Maybe, maybe they are gonna find solutions in western medicine. But like, it is a fallacy that human bodies can all be made to. Be without symptoms. Mm-hmm. With like natural Yeah. You can't buy something that's gonna cure all of your problems. No. And that actually, when we do medical interventions that are unnatural, we're preventing human suffering. And that's important too. Mm-hmm.

Sabrina

Yeah.

Claire

That's true.

Mathilde

Yeah.

Claire

Okay, very last question. What's one change you hope to see in

Sabrina

women's

Claire

health in the next 10 years? I'm so tempted to do like a, like a piece on earth or, you know what I mean? Like a very sort of pie in the sky answer. And it's true, like, I do wish for reproductive justice and, and that, for that to mean all sorts of things for that to mean that people can access abortion safely and easily, but also for that to mean that people don't have to worry about raising their children in poverty. That said the answer in my heart is a bit more of a self-serving one. So right now in BC. Only medical doctors do first trimester aspiration abortions. Nurse practitioners don't do them in other parts of the world. That's, that is the case that nps, and other, professionals like midwives and physician's assistants do first trim aspiration abortions, and we've seen that it's actually quite safe for that to be the case. My personal dream and also my dream for the abortion landscape in BC is for nurse practitioners to be doing first trim term aspiration abortions, because I think it would expand access enormously.

Mathilde

Mm-hmm.

Claire

And I think that nurse practitioners, when adequately trained, like we are more than capable of, of doing that

Mathilde

Mm-hmm.

Claire

for, for our clients, it would make abortion more accessible. Oh, for sure.

Mathilde

For

Claire

sure. That's a really good answer.

Sabrina

Yeah.

Mathilde

Well,

Claire

Well, thank you. Thanks for asking for doing

Mathilde

the

Claire

Thank you for your great podcast. This is so fun. I know that.

Mathilde

that people

Claire

are gonna absolutely love this episode. Oh, I hope so. My personal

Mathilde

Oh my

Claire

Okay, great too. Yeah. Great.

Mathilde

so

Claire

much. Fantastic.

Mathilde

So thank

Claire

you.

Mathilde

Yay.

Claire

Yay. Thank you.

Sabrina

Thank you.