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The contraceptive pill

Birth control in Canada is no longer synonymous with the pill. Women here have more options than ever before, but for a variety of reasons the pill remains an overwhelmingly popular choice.

Many women may not know about contraceptives such as injections or the vaginal ring, or that last year Health Canada approved the lowest-dose estrogen birth control pill on the market. Options for emergency contraceptives are also expanding. Even the most effective contraceptive – the IUD, the method of choice for women in health-care fields – is used by less than 8 per cent of Canadian women.

Newer contraceptive methods include the patch, which releases estrogen and progestin through the skin. Like the pill, the patch prevents ovulation and thickens the cervical mucus, making it difficult for sperm to reach an egg.

The vaginal ring is a flexible, rubber-band-sized device that releases similar hormones. Unlike an IUD, inserted by a medical professional, it's inserted by the woman and left inside the vagina for three weeks out of every month.

Estrogen-free options include the shot – injections of progesterone given four times a year. Both the shot and the progestin-only "mini pill" are safe for breastfeeding women and those who cannot take estrogen.

The most effective contraceptive is the IUD, a T-shaped device inserted into the uterus. The IUD changes the endometrial chemistry, making it difficult for sperm to fertilize an egg. It lasts five years and has a failure rate close to zero.

Women can choose between the copper IUD or the hormonal IUD, which releases trace amounts of a progestin-like hormone that reduces menstrual bleeding.

IUDs are the method of choice for women in health-care fields, U.S. studies have shown. But few Canadian women use them, in part because of misconceptions about safety. Many associate the device with the Dalkon Shield, an IUD taken off the market in the 1970s after cases of infection and infertility.

In rare cases, an IUD may perforate the uterus during insertion. But such events are not life-threatening, doctors say. Today's IUDs have a better safety profile than pills containing estrogen, which increase the risk of blood clots and heart disease.

The pill itself has come a long way. Canadians now have access to Lolo, the lowest-dose estrogen birth control pill on the market that was approved by Health Canada in July, 2014.

The least effective birth control methods include the diaphragm, cervical cap, vaginal sponge and male and female condoms. Other methods with a high pregnancy risk include tracking a woman's fertile days using a calendar or basal body temperature thermometer or withdrawing the penis from the vagina before ejaculation.

Since no method is fail-safe, Canadian women need better access to emergency contraception, experts say. Emergency contraception is not the same as abortion, defined as termination of a pregnancy after a fertilized egg is implanted into the lining of the uterus.

Insertion of a copper IUD within seven days of unprotected sex is more than 99-per-cent effective in preventing pregnancy. But this method is not widely known and women may have trouble getting an appointment for insertion in time.

The "morning-after pill" is an emergency contraceptive available over the counter at pharmacies. It contains progestin, which delays ovulation and prevents fertilization of an egg. A more effective alternative is ella, a pill that can be taken up to five days after unprotected sex, instead of three like the morning-after pill. Ella contains ulipristal, a non-hormonal drug that blocks the effects of key hormones involved in conception. It was approved by Health Canada in January and will be available later this year.

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