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taxxy28
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I need help.

I have been with the same partner since '08. Married since '10. We have never used condoms; we've only relied on my birth control pills and he does not pull out. Thank God throughout all these years I have never become pregnant.

We have not had sex in nearly a year, due to living conditions and lots of traveling with family. I have developed of late an extreme fear of getting pregnant. I do not wish to have kids in the next 10 years and we are both aware of this.

I think condoms will hamper our sexual life. It's already lacking, and I know he doesn't not like to wear them. I actually prefer if he didn't wear them either.

I'd like to double up on my birth control. Along with my daily pill, should I consider the copper IUD? I have never been pregnant, so my healthcare provider vehemently suggested against it, among other reasons.

How effective is the sponge? Is it difficult to use? What would my chances of getting pregnant be with the pill + sponge, or pill + spermicide, or pill + IUD? I think out of all of the options, I can try the sponge first.

Thank you!

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taxxy28
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Actually, further thinking about it, preventing pregnancy is WAY more important than condoms. So perhaps I will use condoms with birth control.
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Molias
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Hi taxxy,

Have you seen this article? It can give you a good idea on the effectiveness of various birth control combinations. The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method

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Heather
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If you're around today, taxxy, and have looked at that link and still need some help coming up with one or two sound combinations of methods you feel good about, I'd be happy to help you fine-tune it.

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taxxy28
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It seems there's a slightly better chance with pills + condoms, than with pills + sponge.

I want the BEST CHANCE I can get! Best chance of not getting pregnant.

I don't want condoms to ruin the sex relationship. It would be strange to start condoms having not used them for over 4 years. I don't know what to do.

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Heather
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Okay.

So, let me make sure I have this right:
• You would like the most effective backup you can use WITH your pills, and would like to keep using the pill?
• If that backup is condoms, you're not sure how to introduce them now and want to be able to use them so they enhance your sex life.

Do I have that right?

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taxxy28
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Correct. I'd consider the IUD, only... I'm not the best for that, says my healthcare provider.

Condoms wouldn't enhance the sex life, they'd hamper it. I don't necessarily want it, my husband definitely doesn't like it, but it seems to be the cheapest/most protective way.

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Heather
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Why did your healthcare provider say you weren't a good candidate for an IUD? have you had any uterine or cervical problems, or do you currently have any infections?

You know, what you're saying about condoms isn't true for a LOT of people who use condoms. In fact, we know from several broad studies and a lot of people's anecdotal reporting that many people DO find condoms enhance their sex lives. Can I ask why you feel so sure that wouldn't be true for you?

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taxxy28
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He is someone who has never enjoyed condoms. He really likes without. Also, again we haven't used them in many years.

Healthcare provider said since I haven't been pregnant, there's a big chance it will fall out/get expelled. She suggested against it and said I should just continue with pills. Still though. I'm so torn.

I wish I could get sterilized.

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Heather
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Often times, the people who really dislike them never learned how to use them correctly, never tried enough styles to find one they liked, or just have negative attitudes that are carrying over and making the experience of them using them seem crummy, even when it isn't.

Mind, condoms aren't your only option here, but we could certainly talk about how to use them and what things usually make them something that DOES enhance people's sex lives, versus the other way round, if you like.

Your healthcare provider sounds like they're very behind on their IUD education. That information they gave you is at least ten years old. The current information and best practices with IUDs make clear that they certainly are not only a good fit for women who have been pregnant before, and that the majority of women who haven't been have no higher rate of expulsion of the device than those who have.

Really, a provider you're seeing about contraception who obviously isn't keeping up with their education is never a great choice for that kind of care: can you switch your provider, by any chance?

Also, I hear you saying sterilization is something that sounds good to you, too: why do you feel that isn't an option for you if it's something you want?

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taxxy28
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I don't want kids, probably ever.

But thank you for the advice; I think I will return and ask more about the IUD. It would be expensive but I think paired with pills, it will give me a great chance, correct?

So long as it doesn't get expelled or moved around! There's a chance I pay all this money for the insertion and it might fall out days later, all that money wasted.

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Heather
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Okay: so sounds like talking to someone about sterilization would be a good idea for you, especially if that's a procedure you think you'd want? As well, if your husband feels the same way, he certainly could talk with someone about vasectomy (which tends to be cheaper and less complicated than tubal ligation).

I'd suggest you talk to a different provider about the IUD if you can, since again, someone without current info on it isn't a good choice, and you probably don't want someone inserting it for you who isn't current with their education on it anyway, you know? The effectiveness of IUDs does have something to do with how well a provider inserted them, after all.

IUDs can expel themselves: that's a risk for ANY IUD user, but it's not a common occurrence. If you like, I can take a sec today and check my references for what the exact (current) rate of expulsion is. Mind, it's also not like you'd not know if it happened: you can always check your IUD strings anytime to be sure the device is still in place.

Edit: checked that current rate for you, and on average, with the Mirena IUD, expulsion occurs for around 3% of all users, and with the Paragard copper IUD, for around 7-8%.

[ 02-14-2013, 01:39 PM: Message edited by: Heather ]

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Heather
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Just reviewing this for myself, and yep: looking at all the studies that are current per IUD use in nulliparous women and those who have been pregnant to explore differences in expulsion rates between them still come up with no definitive differences. But like I said, we've known that for a long time now if we keep up with the data and practice guidelines.

Again, I think switching to a different provider if you can for contraceptive care sounds best to me, but if you can't, or you can, but still want to work with this provider per an IUD, what you might suggest is that she review the American College of Obstetricians and Gynecologists most recent practice bulletins on IUDs to update her information/education on IUDs and who is and isn't a sound candidate, since hers sounds out of date (unless she's just saying she has a preference of not inserting them for nulliparous women, which she certainly gets to have: doctors do have the right to choose what procedures they are or aren't willing to do, but when it's about that, should be giving patients who want them a referral to another provider).

She can find the most recent of those practice bulletins here: http://www.acog.org/Resources_And_Publications/Practice_Bulletins/Committee_on_Practice_Bulletins_--_Gynecology/Long-Acting_Reversible_Contraception_--_Implants_and_Intrauterine_De vices

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taxxy28
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Thank you! I actually might consider the Paragard! Thank you for your time.
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Heather
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The Paragard, just FYI, is the one with the higher expulsion rates and the one that is usually NOT the one most suggested for IUD users who have not previously been pregnant.

It's still okay for those folks, it's just that since it already has an expulsion rate more than twice as high as the Mirena, the prevailing (and sound, I'd say) logic is that with a population which *might* have higher rates of expulsion, and which often does have slightly higher rates of discomfort, you want to let them know they'd probably do better with the IUD with lower overall rates of expulsion and overall better rates of user comfort.

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taxxy28
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If I got the Mirena, that is the one with hormones. Wouldn't my pills interfere with that? I don't want to double up on hormones.

I've been doing research on IUDs. Now I'm unsure about if I want it. What are your thoughts on sponges? They are so pricey and only 3 in a box, and you cannot resuse them. Guh I am so at a loss here.

So. Pill is certain. I'm at 97% with perfect use, correct? Other than condoms and IUD, what can be used that won't suck away at my wallet?

I suppose I can try the sponge. It does have spermicide. Sponge + pill is better than only pill...

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Heather
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If you have an IUD inserted, it'll be something that replaces your pills, not something to use WITH your pills, no matter the type.

Did you look at that link given to you about rates of paired methods? If so, you'll have noticed the section for the pill didn't include the IUD: that's because they aren't two you can combine. (And if this is the conversation you had with your doctor, than it may be I misunderstood, and she's not lacking in current education, but was trying to tell you the IUD isn't a method to pair with the pill.)

And you wouldn't have to, anyway: the IUD is much more effective than the pill in typical use, and it's perfect use rate is much more practically doable. Perfect use with the pill in real-life, not in a clinical study, is highly unlikely for most users in one year.

So, let me check back in again here: are we talking about finding you a new, more effective method, pill or no? Or, do you definitely want to keep taking your pill, so we're talking about what methods you can pair with that one safely and soundly?

[ 02-14-2013, 02:03 PM: Message edited by: Heather ]

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taxxy28
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I want to continue my pills absolutely.

I did see that link. Okay, I understand you. See, I'd want to use my pills AND have the IUD. I would use both for more protection. If I can ask, what would happen if I used both pills and IUD together?

Our strategy is finding a suitable partner with my pills that's not condoms.

Pills + ???

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taxxy28
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Bottom line: I have been using only pills for 4 years. Husband comes inside me. Now I do not want that risk. I want to add another barrier with my pills.
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Heather
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You're not at all likely to find a doctor who would both prescribe the pill for you AND okay an IUD at the same time. They simply are not meant to be sued together for most people.

What could happen? Well, no matter what type of IUD you had, you'd likely see increased side effects. Like, the spotting and unexpected bleeding that often happens with the Paragard would probably happen more, for example.

But really, the issue is simply that medical practice doesn't support them being used together. For more of the why's on that, you can talk to your doctor. And that's sound, since there is no need for both,anyway, unless one of them is given for a health condition.

To make more sense of that for you now, if you want, it'd be a bit like saying you need dinner. So you go and get dinner and you're as full as full can be, you couldn't eat another bite, but you order another dinner, even though you can't eat it. With long-acting contraceptives, the most effective there are available, adding a second hormonal method is just like trying to have a second dinner when you're already full from one. It's just not needed, and can also make a person sick. Not the best analogy, but hopefully that makes sense of it for you.

So, from that link we gave you to look at, here's what we've got for second methods that CAN be used with pills, and their estimated effectiveness rates when combined:


Combination Oral Contraceptives ("The Pill")

99.7% effective alone with perfect use - 92% effective alone with typical use
Combination OCP + Cervical Barriers = 99.98% effective with perfect use - 98.88% effective with typical use
Combination OCP + Male Condoms = 99.99% effective with perfect use - 98.8% effective with typical use
Combination OCP + The Sponge = 99.97%effective with perfect use - 98.72% effective with typical use
Combination OCP + Female Condoms = 99.98% effective with perfect use - 98.32% effective with typical use
Combination OCP + Withdrawal = 99.98% effective with perfect use - 97.84% effective with typical use
Combination OCP + Spermicide = 99.94% effective with perfect use - 97.68% effective with typical use

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taxxy28
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Would a cervical barrier really have that much more effectiveness than a sponge? It seems a sponge is easier and softer.

What is a cervical barrier? Can they be reused? I am prone to UTIs.

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Heather
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Diaphragms and cervical caps have higher typical use and perfect use effectiveness rates than the sponge, so yes.

And those are cervical barriers.

But if you're inclined to getting UTIs, not only might they -- and that includes the sponge, also a barrier with spermicide -- not be the best choice for you, that might be one more reason why condom backup WOULD be a good choice for you. We have some study and data that supports condom use as something that can help prevent UTIs.

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taxxy28
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I could try it. Are these available at the drugstore or do I get them at my clinic?

And sorry -- are they reusable? Or would I have to always purchase new barriers?

What would you say the general chances of getting pregnant would be if I used pills + cervical barrier? Not looking for percentages or numbers, but your opinion?

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Heather
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Diaphragms and cervical caps are available by prescription only because you have to be fitted for them.

They are reusable, usually for years unless you become pregnant and give birth, in which case you may need to be refitted. The spermicide you need to use with them is the part you'd have to buy more than once.

The rates you're asking for are on that link we gave you -- from a piece I wrote -- and right above where I linked them.

So, again, that's: 99.98% effective with perfect use - 98.88% effective with typical use

In other words, awfully close to0, as close as it gets with any method or combination of methods, so long as they're used properly.

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Heather Corinna, Executive Director & Founder, Scarleteen
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taxxy28
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It sounds like I should just abstain from sex if I truly wanted the best chance to not get pregnant!

It seems cervical barriers are a hassle.

But thank you for your insight.

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Heather
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Btw, one way to see how you might do with a diaphragm or cervical cap is to go ahead and try the sponges. They're used very much in the same way, and if they don't land you with UTIs, the others probably wouldn't either.

And that way you can only spend a little money to see if you'd even like them, rather than paying for an exam visit for a fitting, then the $60 - $75 or so for a diaphragm or cap without having any idea of if they're something you like using.

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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You know, ANY method of contraception can be a hassle. Seriously. But more times than not, when we find a method or two that's a good fit for us, when we learn how to use it, and when our partners are on board and cooperate? And when we also recognize a pregnancy we don't want is a WAY bigger deal and "hassle," so methods we can use and afford that work for us are a total cakewalk in comparison? (In other words, if we make an attitude adjustment about controlling our reproduction being a hassle should we have that attitude.)

That initial hassle, if there is one, turns into no kind of hassle at all.

By all means, not having the kind of sex that can create a pregnancy at all certainly is the best way to avoid pregnancy. But it's not the only way, and if you want to have that kind of sex, that's obviously not going to be a sound answer.

[ 02-14-2013, 02:27 PM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
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taxxy28
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Thank you! Hahaha I was thinking...

What if he used a condom, pulled out, I used a sponge, and I'm on the pill. Oh man. It wouldn't go that far, but this is just how I'm thinking.

Thank you again.

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Heather
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Honestly, I'd say that if that's the way you're thinking, then it's pretty clear you're a person who really wants a highly effective long-term method like an IUD, an implant or a tubal ligation or vasectomy.

OR maybe someone who needs to do some more per education about contraception? After all, one you add one more method to the pill, no more on top of that are likely to be able to do anything.

OR maybe someone who needs to talk with their partner about how strongly you feel you do not want to have kids, and make some agreements about what you would do if there WERE an unintended pregnancy, like reaching an understanding that abortion would be what you'd want to do.

Or maybe you could stand to do all of those things?

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taxxy28
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I wouldn't feel comfortable at all just using one form of contraception. I don't know why I feel the need to use two now.

Again I would feel extremely uncomfortable only relying on an IUD, and stopping pills. As for an implant, I'd consider that but also use pills!

Would the implant + sponge be a better partnership than pills + sponge?

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Heather
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You can't use the implant and pills together. They're both hormonal methods. Again, the methods you CAN use with the pill are the ones listed in that link we gave you which I also put on the page for you here a few posts back.

I keep getting the impression that when you're asking about some of this, it's because you don't know about the effectiveness rates for the methods you're asking about.

So, how about we do this: how about you go through this: Birth Control Bingo!

That's a section of the site which you can either:
a) Use the walk-through to find your own best methods, with questions to get each person there, and/or
b) Look at each individual page for each method to see things like effectiveness rates, side effects, etc.

What do you say you take some time to go through that, then we can talk more afterwards, so our conversation is a bit more informed from the get-go?

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taxxy28
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Agreed! I've been looking through this page.

I've read pages upon pages of horror stories of women getting pregnant while on the pill with faithful use. I cannot be that woman.

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Heather
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People become pregnant, every year, with EVERY method. Literally: every single one.

And you can know exactly how many by looking at those effectiveness rates: that's what they tell you. For example, that 92% effectiveness rate for the pill in typical use means 8 out of every 100 women using it in one year became pregnant. The 99% typical use rate for the IUD (whose typical and perfect use rates are almost identical, very different than with user-controlled methods like the pill), means 1 in every 100 did. Get the gist?

But if you're looking for a method or combo where NO ONE EVER gets pregnant? Sorry to tell you, there isn't one. Not a one. So, if you want absolutely no risk of pregnancy at all? Then not engaging in the kind of sex that presents that risk is the only way to get that.

Otherwise, the best you can do is to use the most effective method, or combination of two methods that can be used together, to get as close to that 0% as is actually possible. Two methods used properly, all the time, combined will rarely fail.

Mind, if any method or combo ever does fail, it feels important to remind folks that also doesn't mean anyone has to become a parent or stay pregnant: pregnancy does not have to mean staying pregnant when someone doesn't want to.

I'd also suggest maybe putting your best effort into reading credible, educational materials about contraception, not horror stories. When making these choices, we need good information to do so. Misinformation, or people panicking, or not being totally honest, or being honest, but in ways that aren't sound (like claiming the pill doesn't work because they were someone it failed), just doesn't tend to help people make these choices at all well.

[ 02-14-2013, 03:26 PM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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taxxy28
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Thank you. Which brings me to another question.

In the state of Texas, generally how much do abortions cost? I can say that I wouldn't be affected much by one, since I am not a motherly person and don't wish to have children ever, but I've been told abortion absolutely affects the woman in many ways.

If I had an abortion, and years later became pregnant, would the doctor be able to tell I had one? Am I allowed to withold that information?

Also, are there any natural remedies that may lead to natural sterility in women? I've heard of several Indian herbs to be ground and consumed in tea for 6 months. Who knows if these really work.

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Heather
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A lot of what's said about abortion is said by people without any actual education about abortion and the realistic of abortion.

The cost of abortion varies a lot depending on how far along someone is. But for basics like what abortions typically can cost and other sound information about abortion, you can read up right here: All About Abortion

By all means, not telling a doctor about your reproductive history with reproductive healthcare isn't a wise idea. being honest about our health and medical history with healthcare providers is an important part of helping them to do their jobs well.

Could a doctor tell if you terminated, versus gave birth? Usually not. Could they tell that you had been pregnant before? Yes, often enough: the cervical opening tends to change shape with pregnancies, whether they end in miscarriage, abortion or delivery, though the most noticeable changes are for those who stayed pregnant and gave birth or who had miscarriages or terminations after the first trimester.

On that Birth Control Bingo page, with the exception of surgical sterilization, we list ALL the current, reliable known methods of preventing pregnancy. If something isn't listed there -- again, with the exception of tubals and vasectomies -- it's because it isn't a reliable method, or isn't something studied to let us know yet if it works.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me • Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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