LGBTQ: Contraception

Contraception, or birth control, is important for anyone that does not wish to become pregnant. Especially those who are sexually active, are thinking about becoming sexually active, or just aren’t sure yet. It’s always a good idea to plan ahead for those “what if” moments. Teens of all genders who were sex assigned female at birth can benefit from contraception!

For the purposes of this guide we will use anatomic terms (e.g., vagina), but we know people use a spectrum of terms to describe their body (e.g., genital opening, front opening). You should discuss with your clinician if there are alternative terms you prefer to use to describe your body or the way it works.

What types of contraception are there?

You have a lot to choose from when it comes to contraception. The type of contraception you choose may depend on a number of factors including your anatomy, side affects you do/do not desire, and the partners you plan to have sex with. It’s important to know the different types of contraception methods available for individuals, especially if you are sexually active. It is a good idea to discuss with your clinician which contraceptive methods are best for you and your partner’s health and safety.

Here are some things to consider when choosing contraception:

  • How much do they cost?
  • How effective are they at preventing pregnancy?
  • How easy are they to use?
  • Will they protect me against sexually transmitted infections (STIs)?
There are other considerations that may be unique to each person. See table below. (Adapted from https://pubmed.ncbi.nlm.nih.gov/31394072/)
Contraception TypeInvasive/Pelvic ProcedureContains EstrogenEffect on BleedingPrivacy/ Concealability considerationsFrequent DosingNeed to see a doctor to discontinueEfficacy (perfect/typical)
Combined Oral ContraceptivesNoYesMay reduce or stop bleeding if taken continuouslyPill packDailyNoPerfect: 99%

Typical: 91%

Progesterone only contraceptive pillNoNoMay reduce or stop bleeding if taken continuouslyPill packDailyNoPerfect: 99%

Typical: 91%

Combined Hormonal PatchNoYesMay reduce or stop bleeding if taken continuouslyPack of patchesWeeklyNoPerfect: 99%

Typical: 91%

Combined Hormonal RingSelf-inserted into vaginaYesMay reduce or stop bleeding if taken continuouslyRing must be stored in refrigeratorMonthlyNoPerfect: 99%

Typical: 91%

Depot MedroxyprogesteroneNoNoReduces or stops bleedingGiven at your health care providers (HCP) office.Every 10-13 weeksNoPerfect: 99%

Typical:94%

NexplanonInserted under skinNoReduces bleeding (more rarely stops it)ConcealedOne lasts multiple years*YesPerfect: 99%

Typical: 99%

Progesterone IUDYesNoReduces or stops bleedingConcealedOne lasts multiple yearsYesPerfect: 99%

Typical: 99%

Copper IUDYesNoHeavier BleedingConcealedOne lasts multiple yearsYesPerfect: 99%

Typical: 99%

HysterectomyYesN/AStops bleedingN/AOne procedure, permanentN/APerfect: 100%

Typical: 100%

 

 

It’s recommended that you use two types of contraceptive methods to help boost your protection against pregnancy and also protect against STIs. For example, you can use the birth control pill in addition to condoms. It’s important to remember that while only those born with a uterus (most of whom were assigned female at birth) can get pregnant, anyone can get an STI. If you have unprotected penile-vaginal sexual intercourse and come in contact with semen you are always at risk for pregnancy and sexual intercourse with a partner of any anatomy put you at risk for STIs. If you practice safer sex, limiting your number of partners, making sure you get tested for STIs to know each other’s status and making informed decisions about contraception, you can greatly lower your risk.

Examples of contraceptive methods:

IUDs

An Intra-Uterine Device (IUD) is a small, T-shaped device that is inserted through the vagina and cervix into the uterus by your healthcare provider, to prevent pregnancy.

There are more than one kind of IUD. Some IUDs (Mirena®, Skyla®, Kyleena®, and Liletta™), contain the hormone levonorgestrel (a type of progesterone). IUDs that contain hormones (levonorgestrel), do a great job of making uterine bleeding much lighter or in some cases cause it to go away entirely.  IUDs are over 99% effective in preventing pregnancy, this mean that’s if 100 people use an IUD, less than 1 person will become pregnant in year.

Here are 4 great reasons to choose an IUD:

  1. Less stress – You don’t have to remember to take a pill every day.
  2. Great option for everyone – Hormonal IUDs can be used with other medications used to affirm gender such as testosterone.
  3. Heavy flow? No problem, Hormonal IUDs are a great option for reducing bleeding
  4. Safety – IUDs are safe and proven to be 99% effective against pregnancy.
  5. Privacy – The IUD is not visible to others, you can chose if and when you tell others about your IUD.

Before your IUD is inserted, your healthcare provider will need to perform a pelvic exam in order to place an IUD. This may make you feel uncomfortable, nervous, or dysphoric especially if you are Trans or non-binary. If you’re feeling uncomfortable or anxious, talk to your provider before your appointment, they may be able to prescribe you some medication to feel more relaxed. It’s also possible to receive a medication in the office (anesthesia or sedative) that will make you sleepy, to prevent the feelings of dysphoria, anxiety, or discomfort. If you’re worried, it’s always helpful to bring someone you trust along to your appointment to help you feel safe.

Depo-Provera® Hormonal Injection

Depo-Provera ® is a hormonal (progesterone) method of birth control. That is given as an injection by your health care provider, every three months. When given at the same time, every 3 months, Depo- Provera ® is 99% effective at preventing pregnancy and its private (no pills to carry around!). It’s also good at controlling or stopping bleeding, however some irregular bleeding is expected to occur with the first injection. Another great reason Depo-Provera® is so great is, you don’t need a pelvic exam to use Depo-Provera. Depo-Provera ® has one downside – if you don’t like how the injection works or how it makes you feel, it can take time to wear off, especially if you’ve been receiving them for a while.

Nexplanon® Hormonal Implant

Hormonal implants (Nexplanon ®) is a type of birth control in the shape of a tiny piece of plastic that goes under the skin in your arm by your healthcare provider. They are about the size of a toothpick and made of a flexible plastic which contains a type of progestin hormone called etonogestrel. Nexplanon ® is 99% effective in the prevention of pregnancy for 3 years. The implant is convenient because it’s private (no pills to worry about) and it can be placed and removed in your health care providers office.  As with any birth control methods, there are downsides, with Nexplanon ® one of the most common side effects is irregular bleeding. Unfortunately, there is no way to know how your body will react until you try it, but if you don’t like it, your provider can easily take it out. Depending on the person, someone may prioritize pregnancy prevention over stopping bleeding; it all depends on your goals. .

The Mini-Pill

The mini-pill is the progesterone only pill. The pill is about 91% effective and you need to take it every day at the same exact time for it to be effective. The mini-pill is safe and easy for you to control since it’s a pill. While some people don’t bleed at all with the mini-pill, it is normal to have some irregular bleeding, too.

The Pill, Patch or Ring

The pill, patch and ring are all methods that contain both estrogen and progesterone. The pill is taken every day, the patch is worn on your skin (anywhere except your chest) and is changed weekly, and the ring is used in the vagina. All of these methods can be used to stop or reduce uterine bleeding, and are between 91-99% effective at preventing pregnancy.

Condoms

Condoms and barrier methods (such as dental dams and latex condoms) should always be used for sex, whether or not you’re on another form of contraception. Although other methods of contraception are great, contraception alone won’t help protect you or your partner against sexually transmitted infections (STIs).  External condoms are worn on a penis and work best when put on correctly. Internal condoms can be used in the vagina to prevent pregnancy, and can be used for anal intercourse as well. Condoms are most effective when you use them with another form of contraception (like an IUD, for example). Ask your health care provider (HCP) if they have any free condoms to offer you!

Hysterectomy

Hysterectomy is the surgery where the uterus, tubes, and sometimes the ovaries are removed.  Hysterectomy is 100% effective in preventing pregnancy and stopping uterine bleeding. Hysterectomy is permanent, so you have to be absolutely certain that you do not want to carry a pregnancy in the future. Hysterectomy is not typically considered until after a person reaches adulthood.

What do I do in an emergency?

Emergency contraception is for those who have had sex that could lead to pregnancy without a reliable method of routine contraception. This is for those situations where a condom breaks, sex occurred without a condom, or you do not have another form of birth control. It’s important to remember emergency contraception (EC) does not work if the women is already pregnant, as it will not cause an abortion. There are three types of Emergency Contraception.

Copper Intrauterine Device: Copper T IUD (ParaGard®)

This IUD is a small copper device that when placed in your uterus (through your vagina), not only prevents current pregnancy but future pregnancies for up to 10 years as long as it remains in place. Although the Copper IUD is one of the most effective methods of emergency and ongoing birth control, it can cause more pain with periods and heavier bleeding. For some people, this can contribute to dysphoria. It can also be uncomfortable to have placed.

Levonorgestrel (1.5mg pills) Plan B One-Step®, Next Choice One Dose®, MyWay®, AfterPill™

Plan B is a pill you can take to help delay ovulation and prevent pregnancy for up to 3 days (72 hours) after unprotected intercourse. There is some pregnancy prevention up to 5 days, but the sooner the better. The pill is available over-the-counter (OTC), meaning you can go to your local pharmacy, walk in, and pick-up the medication without a prescription! The cost will depend on where you pick it up, so it’s always a good idea to call the pharmacy and ask about coupons ahead of time. It’s important to keep in mind that you may or may not experience some bleeding after taking Plan B. If you have any questions or concerns, call your health care provider (HCP) right away. .

Ulipristal acetate (30mg) includes Ella™

This is one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is often needed for this pill, but in some states a pharmacist can dispense Ella without a prescription. In many cases, a pregnancy test is also needed. Your health care provider can write you an “advanced prescription” for Ella it will be available for you if you have unprotected sex in the future. Talk to your health care provider about this option.

Are emergency contraceptives (EC) perfect?

No method of emergency contraception (EC) is perfect, so it’s important to take a pregnancy test in 3-4 weeks after using (EC). If you develop abnormal bleeding, pain or pregnancy symptoms (nausea, chest tenderness, etc.), call your health care provider (HCP) right away.

Frequently Asked Questions (FAQ)

Do my parents need to know I’m getting contraception? I don’t want them to know I’m sexually active.

No, contraception should be a confidential service. This means that your healthcare provider (HCP) should not tell your parent or legal guardian that you’re receiving contraception. If you’re nervous, tell your HCP that you are seeking care that is confidential and you do not want your parents or legal guardian to know. Remember that it can be helpful to talk to you parent or guardian or a trusted adult about your sexual health.

Can I take contraception while on testosterone?

Some trans-masculine teens may worry about these methods working against the effects of gender-affirming hormones (such as testosterone). In most cases you are able to safely take these contraceptive agents, even hormonal ones alongside testosterone. It’s important to speak with your own healthcare provider so they can help you pick the right method for you and discuss if there is any reason one might be better for you while on testosterone.

My friend was telling me that being on T (testosterone) works as contraception. Is that true?

This is a common misconception! No, testosterone may stop bleeding but it will not protect you against pregnancy!

What are some things I should consider when choosing a form of contraception?

Everyone’s goals regarding contraception may be different. The below chart are some things individuals might consider when choosing a method. See if any of these are ones that matter to you!

People born with a uterus, may benefit from contraception, regardless of their gender. Learn more about who should consider contraception and what options might be available for you!