Three experts set the record straight on the most common misconceptions about birth control.
By Colette Bouchez
Reviewed By Brunilda Nazario
Does the birth control pill cause cancer? Can an IUD cause painful sex? Will a diaphragm protect against a sexually transmitted disease?
If you're like many women you may not know the answers -- or worse still, be all too familiar with the myths and not the facts that seem to swirl around nearly every method of birth control. Indeed, doctors say that so much misinformation is going round about birth control even they sometimes get confused about what is and isn't true.
"Sometimes I'll hear something repeated so many times from so many different patients I'll actually have to do some research myself to make sure the facts haven't changed," says Steven Goldstein, MD, professor of obstetrics and gynecology at NYU School of Medicine in New York.
Among the most troubling of those myths says Goldstein, is fears about a link between the birth control pill and cancer; a common misconception that keeps many women from using this highly effective method of birth control.
The good news: "The pill is not a cancer-causing agent, but a cancer-reducing agent, with good science to show that with continued pill use there's a dramatic and continued reduction in the incidence of ovarian cancer, and even uterine cancer," says Goldstein.
But what about breast cancer? Gynecologist Margaret Polaneczky, MD, puts those fears to rest as well.
"In general, the message is that it does not impact the risk of breast cancer in most women," says Polaneczky, an associate clinical professor at the Joan and Sanford Weill Medical College of Cornell University in New York City.
The birth control pill's other health concern -- the risk of blood clots -- is slightly more complex, but again doctors say not an issue for most women.
The risk of blood clotting complications such as leg clots or lung clots is about 1 in 1,000 for all women; the risk rises to 3 in 1,000 for women on the pill, so clearly it's not something the majority need to worry about," says Goldstein.
That, however, can change as you age or if you smoke, since doctors say both factors can further increase risks.
In addition, Polaneczky says women who suffer from severe migraines, particularly with neurological symptoms such as arm or leg weakness during a migraine, may also be at increased risk for clotting complications from being on the pill. He says they might want to consider a different form of birth control.
"This should not be an issue if you have a menstrual-related migraine; only if you have neurological complications," says Polaneczky.
While the pill certainly has its share of myths, so too do other forms of birth control. Among the most misunderstood, say doctors, is the intrauterine device (IUD).
Initially it was removed from the market due to the safety issues of one particular IUD design known as the Dalkon Shield (in use from 1971-1974). Today, however, the redesigned IUDs are believed to be both safe and effective.
Still, among the top concerns: That it can interfere with tampon use; that it can dislodge during sex; that it can cause sex to be painful; that it can be felt by a partner. Experts say the answer to all is "no."
"An IUD will not interfere with tampon use, and, when properly inserted, it should not get dislodged during sex or cause you any pain, and your partner should not feel it either," says Erika Banks, MD, associate residency director of obstetrics and gynecology at Montifiore Medical Center, Bronx, N.Y.
If any of these things do happen, says Banks, it's likely the IUD was not properly inserted, so see your doctor. And while sometimes a woman's body can expel an IUD on its own, experts say that is rare and usually occurs only in women who have never had children.
"This is one reason why most doctors continue to suggest an IUD only to women who have had children; generally, the uterus is larger and it not only holds the IUD better, it also is easier to insert it correctly," says Banks.
The other common IUD myth: That it can increase your risk of contracting a sexually transmitted disease. Doctors say that it won't; only unprotected exposure to an infected partner can do that. However, if you should contract an STD while wearing an IUD, then Goldstein says you may have a greater risk of infection to your reproductive tract and pelvic inflammatory disease.
"The wick or tail of the IUD can carry the bacteria deeper into the body, allowing it to reach both the uterus and the fallopian tubes," says Goldstein. For this reason most doctors do not recommend an IUD to any woman who is not in a guaranteed monogamous relationship.
To help break the myths and deliver the facts, our three experts set the record straight on these additional birth control concerns.
1. Myth: Missing 1 pill will increase my risk of pregnancy.
Fact: It won't. Simply take two birth control pills the next day. It is encouraged that you take your pill the same time every day. Doing so can help reduce your risk of breakthrough bleeding. Progesterone-only birth control pills need to be taken at the same time every day, otherwise effective birth control is decreased.
Also note: If you are on the birth control patch and it falls off, put on a new one right away. If more than two days go by without it, then use an alternate form of birth control for the remainder of your cycle.
2. Myth: Antibiotics reduce the pill's effectiveness.
Fact: While there have been individual case reports of women for whom this is true, doctors say overall studies have failed to prove it. The only antibiotic known to impact the pill is rifampin, used to treat tuberculosis. That said, if you are using antibiotics on a regular basis -- to treat acne, for example -- you might experience higher than normal rates of breakthrough bleeding. To solve the problem, switch to a higher-dose pill.
3. Myth: The pill will make me gain weight.
Fact: Most women do not gain weight on the pill. But if you do it is likely to be water retention, limited to about 2 pounds. However, some women find the pill increases their appetite, which in turn causes overeating and weight gain. The solution: Switch to a different birth control pill.
4. Myth: The tighter a condom fits my partner, the more I am protected.
Fact: A condom that is too tight is more likely to burst during intercourse. It's also important to leave some space near the tip to safely catch the ejaculate without straining the condom. Incidentally, neither ordinary balloons nor Saran Wrap are effective substitutes for a condom.
5. Myth: You can safely remove a diaphragm as soon as your partner loses his erection.
Fact: If your partner has ejaculated, you must keep your diaphragm in your body for six to eight hours -- the time it takes for the spermacide to effectively kill all the sperm. Additionally, you must apply a fresh dose of spermacide each time you have intercourse. Without it, you have almost no protection.
6. Myth: The new contraceptive sponge works like a disposable diaphragm.
Fact: Both methods act in a similar manner, as a receptacle for spermacide. However, a diaphragm is fitted to your body and is less likely to dislodge during sex. A sponge may be easier to insert, but it can become dislodged during sex.
7. Myth: My body needs a 'rest' from all birth control at least once a year.
Fact: It doesn't. Regardless of the type of birth control you use, your body does not require you to stop at any point.
An IUD that does not contain hormones should be replaced every 10 years. Some IUDs contain hormones and should be replaced less than every 10 years. A diaphragm may have to be refitted and resized if you lose or gain a significant amount of weight.
Woman who use extended-regimen birth control pills have three months of active pills and extend the time between your scheduled periods.
8. Myth: Using birth control pills may mean it's harder to get pregnant when I finally do try.
Fact: The pill will not harm your fertility, or cause irregular cycles, or prevent you from getting pregnant in the future. You also do not have to wait any specific period of time after stopping the pill in order to safely conceive. The reason some doctors recommend staying off the pill for three months before conceiving: It could take that long for your cycle to regulate. There is, however, no harm in trying sooner.
9. Myth: It's not safe to use birth control pills to manipulate your cycle.
Fact: It is perfectly safe, and doctors have been using the pill in this fashion for decades. Indeed, because you aren't ovulating on the pill, the lining of your uterus does not build during a monthly cycle. Therefore there is no need to shed or "cleanse" your uterus with a menstrual bleed. In fact, the "period" you get while on the pill is not a menstrual bleed at all but instead your body's reaction to hormone withdrawal -- which occurs when you take the seven "placebo" pills in your pack at the end of each month. As such, skipping the placebos and continuing to take the pill without a bleeding break, is not harmful.
10. Myth: All birth control pills are the same, only the dosage changes.
Fact: All birth control pills use the same type of estrogen but can differ in the progesterone formulation. If you are having a problem on one pill -- such as breakthrough bleeding, extreme hunger, or loss of sex drive -- switching to a different brand or formulation will often make a difference.
Colette Bouchez is the author of The V Zone: A Woman's Guide to Intimate Health.
Published May 9, 2005.
SOURCES: Steven Goldstein, MD, professor, obstetrics and gynecology, NYU School of Medicine. Margaret Polaneczky, MD, associate clinical professor, Weill Medical College, Cornell University, New York. Erika Banks, MD, associate director of residency, Montifiore Medical Center, New York.
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