We talked to the experts on contraception in the age of the coronavirus pandemic.
Sex: Many of us love it, many of us partake in it, and many of us don’t want to get pregnant after it. So what do we do when we want to have some fun in the bedroom without the repercussions of an unplanned pregnancy? Use protection, of course.
It all seems pretty simple, but what does “protection” actually mean? To some of us, it’s a lubricant-drenched latex condom, and to others it’s a little pink pill, an IUD, even a spermicidal sponge. With a pandemic still in place limiting many of our rendezvous, some of you may even be questioning why we’re talking about birth control in the first place. But, contrary to what you might’ve believed, birth control may be more popular than ever now.
While some might have predicted a baby boom to happen while couples are quarantined away with each other, the facts are pointing in the opposite direction: Reports show that birth control requests have doubled since the COVID-19 pandemic started. With a study from the Center for Disease Control showing that women who are pregnant are more at risk for severe illness from COVID-19, many people are opting out of starting or growing their families for the time being.
Which brings us back to good ol’ birth control. Though most of us were taught to use condoms in our subpar high-school sex ed classes, it’s surprisingly the least common form of birth control for sexually active women ages 15–49 in the United States, according to a study by the CDC. The study also found that one of the most common forms is oral contraceptive pills—most commonly referred to as “the pill”—and its popularity has only grown as the years have passed.
But there’s been a recent movement of women ditching their packs of birth control pills. Could it be due to the lack of resources to physically get them during this quarantined time? Maybe, but according to Alisa Vitti, women’s hormone and functional nutrition expert and creator of Flo Living, this decline has started to take place long before COVID-19 was even a thought in our minds, for various long-term health reasons.
“Since the whole movement of menstrual mainstreaming started about five years ago, with millennials free-bleeding on Instagram photos, there has been a completely new conversation emerging around periods and young women and one that is intersecting with the world of wellness,” Vitti says. “Meaning, it’s an odd thing for someone to have values that say, ‘Yes, I want to focus on self-care and do yoga and use green organic makeup and make sure I’m not using foods that are containing pesticides, but I’m going to take this medication to shut off my cycle.’”
Wait, shut off your cycle? But even if you’re on the pill, you usually get a period during that week of sugar pills, right? Well, not exactly: Most birth control pills work through synthetic forms of the hormones estrogen and progesterone. These synthetic hormones don’t allow the eggs in your reproductive system to mature, causing your body to completely stop ovulating.
So that period you get when you’re on the placebo pills is not exactly a period. During that week of sugar pills, women usually expel the underdeveloped lining in their uterus, which results in bleeding similar to a “period.” That’s why women who are on extended-cycle pills like Seasonale only get their period seasonally rather than monthly.
“Most women actually still believe that they get a period while they take any form of this medication, whether it’s an IUD, implant, or oral,” says Vitti. “All of the medication completely shuts off your ovulation and your cycle. You have no cycle. You have no reproductive-level hormones. That’s the whole value of it, to prevent you from conceiving, is that it lowers all of your hormones to very, very basic levels so that there’s no cycle at all. The reason why there’s a breakthrough bleed is just so that women feel less freaked out when they go on this that it doesn’t stop completely.”
Though these popular forms of birth control are life-changing—and many times life-saving—their impact on our hormones aren’t necessarily the best, especially in the long run, according to Vitti.
“Every time you ovulate, the hormones that are involved in ovulation confer enormous protective benefits to your brain, your heart, and your bones, and they do that during the reproductive years,” she says. “But every ovulation you have during your reproductive years banks cardio, osteo, and neuro-protective benefits for when you are post-menopausal and no longer bleeding and ovulating. You’re literally robbing, yourself while you’re on this medication, of your future health.”
Long-term effects aren’t the only thing pushing women to get off hormonal birth control options. According to Dr. Charis Chambers, aka The Period Doctor, many women are choosing to opt out of these methods of contraception because the common side effects of mood swings, weight fluctuation, and more don’t feel worth it—especially now, during a pandemic, where many people are reporting a lower sex drive.
“We’re now seeing women start to explore moving away from more traditional hormonal forms of birth control that require daily use or long-term device implantation,” she says. “If we’re not having sex every day, why should we need to take hormonal birth control every day? Are the side effects worth it? These are questions I’m hearing more commonly in my daily practice. Of course, this is not the case for every woman, as hormonal methods are still very vital to women who need them to help manage certain medical conditions and of course personal preference.”
But to be clear, these experts in the reproductive world are far from anti-birth control: This information is simply to help you create a more informed decision on it. So if you choose to break up with your birth control pills or your IUD after reading this information, what’s the next option?
“I always tell my patients that the best birth control is the one that they will use,” says Dr. Chambers. “My advice to anyone who is looking to switch their birth control is to work closely with your doctor about your needs and your lifestyle and to be honest about what you’re looking for in a birth control [method]. I also encourage people to talk to their doctors—and even do their own research—about all of the options that are available, because there are quite a few new options available.”
Though condoms are the only contraceptive that prevents STDs, there are multiple hormone-free options that can prevent pregnancy. One of them is the rhythm method, otherwise known as the fertility awareness method, which is basically exactly what it sounds like: tracking your ovulation cycle to determine when your fertile days are.
“So you’re personally only fertile for 48 hours,” says Vitti. “The issue is if you have introduced sperm up to five days before the egg drops, sperm can live in you for five days. That’s the challenge. So you want to get to know when your timing is because you’d want to start using the barrier methods leading up to ovulation so that there’s no presence of that sperm to potentially fertilize that egg when it does drop. It’s a seven-day maximum situation where you have to use the barrier method. The rest of the time, you don’t have to worry about it if you are tracking.”
Though most of us would proceed with the rhythm method cautiously, Vitti notes that there are new and easily accessible specs within the fem-tech industry that allow us to track our ovulation cycles precisely.
“The fem tech vertical is so exciting because women like me are looking at the substandard healthcare options that we have for our unique female health, and we’re creating products and solutions to make it easier,” she says. “One of the companies that I think has done a fantastic job to help women with the fertility awareness method to make it goof-proof is Daysy. All you do is, before you get out of bed, while you’re still laying down, you insert the little thermometer in your mouth and it sends wirelessly your basal body temperature to your phone, and it keeps a beautiful chart for you over the month.”
Another form of non-hormonal birth control that both Vitti and Dr. Chambers are excited about is a new kid on the block: Phexxi, a prescription vaginal gel applied right before sex that uses ingredients like lactic acid (something you’re probably familiar with from your skin-care routine) to maintain your vaginal pH, lowering the chance of sperm reaching the egg.
“Phexxi is the first and only hormone-free prescription vaginal gel that works by maintaining a vaginal pH level that is inhospitable to sperm,” says Dr. Chambers. “When semen enters the vagina, the pH level is increased to help sperm survive. Phexxi works to maintain vaginal pH, which reduces sperm mobility, lowering the chance of sperm reaching the egg.”
“I think it’s an enormous leap forward in terms of [birth control],” adds Vitti. “It’s a safe barrier method that you as a female can be in control of. It doesn’t prevent STDs, obviously, like condoms do, and so condoms will forever be, in heterosexual partnering, the gold standard of both contraception and safety, but if you are with a long-term partner and you don’t want to have condoms all the time, and let’s say you are in that seven-day window leading up to ovulation, you can use Phexxi for those seven days. Then the rest of the time, if you’re using a product like Daysy, you don’t have to use anything.”
Overall, pandemic or not, your choices in contraceptives are more vast than ever—it’s just a matter of educating yourself to find the right choice for your body.
“I think it’s just an extraordinary time,” says Vitti. “There’s more options than ever before, and women CEOs and founders like myself, like Saundra [Pelletier], we’re behind driving this change for more options, more safety, and better healthcare.”
[Editor’s Note: As ever, we are not doctors or medical know-it-alls. And everybody is different, so make sure to check with a doctor before trying anything new.]
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