Got questions about birth control?
IMPORTANT NOTE: Hormonal methods of birth control do not protect against sexually transmitted infections (STIs). Only barrier methods like male or female condoms do.
For condoms, see the WTF feature here.
I DON’T KNOW ANYTHING ABOUT BIRTH CONTROL!
Great, you’re in the right place!
Birth control is not just about preventing pregnancy or practicing safer sex. It is about empowering yourself – regardless of gender – to take charge of your fertility and engaging in healthy, responsible sex.
It is not just limited to condoms or pills. It includes fertility awareness (see below) methods, withdrawal, abstinence, or simply engaging in non-PIV (penis in vagina) sex.
To make an informed decision, use the explorer guide to decide which is best for your needs:
I AM A MAN. WHAT DOES BIRTH CONTROL HAVE TO DO WITH ME?
Everything! We believe that everyone, regardless of gender, should be equal partners in sharing responsibility for safe sex. Reproductive health should be basic knowledge for everyone.
Sex should be informed, consensual, and fun. Not knowing about birth control risks can lead you to make irresponsible choices (e.g. Thinking that she can just take a morning-after pill , right? Isn’t it as simple as that? Well, no, it can be expensive, not always effective, and can cause many unpleasant side effects for the user).
Watch this cool five-minute series on men and birth control:
Here’s some men’s perspectives on emergency contraception:
Knowing about birth control will help you know your partner’s body better, understand the changes that might be happening to their body, and be a more supportive partner throughout the sometimes-frustrating process of finding the right method of contraception.
Men, too, can be active participants in birth control: using condoms, the withdrawal method, having non PIV sex. You can even read about how we are only years away from doctor-approved effective, reversible male birth control methods.
HOW EFFECTIVE IS BIRTH CONTROL AT PREVENTING PREGNANCY?
HBC methods work by affecting the production of reproductive follicle-stimulating and luteinizing hormones. That causes a threefold effect: it prevents ovulation (no egg released means no egg to fertilize), it thins the lining of the uterus, making it an inhospitable places for a fertilized egg to try and implant (and thus for most people, making periods lighter and shorter,) and it thickens cervical mucus, making it much harder for sperm to survive.
For more information on the exact mechanism of hormonal methods, see here.
As seen from this table, HBC methods are the most effective reversible contraception methods available, with a 0.3% failure rate for perfect use and 8% failure rate for typical use. The main source of ‘failure’ that comes with so-called typical use is taking pills late or missing them entirely without using backup protection (e.g. condoms, emergency contraception) when that happens.
Doubling up (or tripling! – whatever suits you and your partner’s comfort level for sex and pregnancy risk) on birth control methods can significantly increase your protection. To see statistics on various birth control combinations, check out this Scarlet Teen ‘The Buddy System’ article.
I DON’T KNOW WHERE TO GET BIRTH CONTROL
In Singapore and most other countries, hormonal birth control methods are available only by prescription from a doctor. Your doctor will be able to prescribe birth control pills. If they do not have it, they can write you a prescription to purchase it from a pharmacist (e.g. at Guardian, Watsons, Unity, etc). Should you have preexisting gynaecological conditions and/or require a specific type of birth control like the vaginal ring, the patch, implant, or IUD, they may refer you to a gynecologist instead.
In Singapore, a pack (ie. one month’s supply) of birth control pills from a GP typically costs between $20 – $30 depending on doctor and brand. Some common brands in Singapore include Yasmin, Yaz, and Diane-35.
Your health insurance plan may help cover costs of birth control.
To be sure, call your doctor beforehand.
It is recommended to NOT use HBC if you smoke and are over age 35. Smoking increases your risk of serious side effects from the hormones, which can include life-threatening blood clots, stroke, or heart attack. This risk increases with age and number of cigarettes smoked.
DO I NEED A PELVIC EXAM BEFORE GETTING BIRTH CONTROL?
The short answer is: no, you do not need a medical or gynaecological exam before getting birth control pills. Doctors will ask routine questions like “Do you smoke?” or check other existing health conditions. It is recommended to NOT use HBC if you smoke and are over age 35. Smoking increases your risk of serious side effects from the hormones, which can include life-threatening blood clots, stroke, or heart attack. This risk increases with age and number of cigarettes smoked.
In addition, if you have an existing reproductive health problem like painful sex, vaginal bleeding, painful and heavy periods, a pelvic exam may be a good idea.
I’M AFRAID THAT MY PARENTS WILL FIND OUT
It is routine and lawful medical practice for your doctor to keep your medical records confidential. You can also consult a doctor other than the one your family sees.
It is also easy to discreetly use birth control methods.
For added confidentiality, ask your doctor about how you will be billed on your account or insurance statement. If it explicitly states birth control, you can request for it to show up as miscellaneous fees.
I’M HAVING BAD SIDE EFFECTS
Most of the time, the side effects should subside quickly as there is an adjustment period when starting hormonal birth control of 1-3 months. If they do not go away after 3 months or are unbearable, inform your doctor. They will be able to talk to you about the situation, and switch your prescription, if needed. Sometimes finding the right hormonal birth control for you takes time, trial, and error. Hang in there!
If you’ve waited out the 3 cycle adjustment period, and one particular side effect just isn’t going away, you may want to consider switching to a new formulation of HBC. This page suggests that certain side effects such as bloating, headaches, nausea, etc are often related to estrogen levels. These side effects may be minimized by switching to a formulation with a lower estrogen content. Similarly, side effects such as mood swings, depression, fatigue, decreased libido, and weight gain may be related to the strength or type of progestin in the formulation. Switching to an HBC type with a lower progestin potency may lessen these side effects.
It is useful to note that pills containing 20mcg of ethinyl estradiol (the lowest dose available) may have increased rates of breakthrough bleeding compared to formulations with higher estrogen contents as there might not be enough estrogen to sustain the endometrium’s stability. Should prolonged and heavy bleeding occur, consider switching to a higher-dose pill.
IS IT EXPENSIVE?
In Singapore, a pack (i.e. one month’s supply) of birth control pills from a GP typically costs between $20 – $30 depending on doctor and brand. Some common brands in Singapore include Yasmin, Yaz, and Diane-35.
It is also possible to buy birth control pills over the counter at pharmacies in nearby countries like Thailand or Vietnam where it is cheaper. However, do so at your own risk as it is not from a doctor and may be expired, fraudulent or plain unsafe.
Other methods, like the implant or IUD tend to be more expensive as they need to be inserted by a trained gynaecologist. After insertion, they also last longer – balancing out costs in the long run.
Your health insurance plan may help cover costs of birth control.
Talk to your partner about splitting the costs of birth control! They should be an equal partner too, as preventing pregnancy is the responsibility of both parties, not just the woman. Think about it – the cost of having a child WILL be far more expensive!
Watch this video featuring 4 women who talk about their experiences with splitting costs:
WHAT IF I HAVE HAD UNPROTECTED SEX AND AM WORRIED ABOUT PREGNANCY?
If taken within 5 days (120 hours) after having unprotected sex, emergency contraception in the form of the ‘morning after pill’ is your best bet. It works by delaying ovulation. So if you have already ovulated, it may not work. The sooner it is taken, the higher the rate of effectiveness is. Refer to AWARE for information on obtaining EC in Singapore.
Alternatively, a substitute for the MAP is taking a higher dosage of regular birth control pills containing norgestrel or levonorgestrel. Users already taking those pills might find this method more convenient. For more information, refer to Princeton University’s website.
For a lesser-known EC alternative, The World Health Organization also recommends the insertion of copper IUD as an effective emergency contraceptive method.
You can be sure about a possible pregnancy by taking a pregnancy test. These highly-accurate tests test for HCG in urine which is only produced by pregnancy or certain fertility drugs. A positive result can show up at any time, but 19 days after the instance of unprotected sex you can be certain that there are no false negatives.
Some common signs of early pregnancy can include: missed menstrual period, implantation bleeding, swollen/tender breasts, fatigue, frequent urination, nausea/”morning sickness”, food cravings, headaches, backaches and so on.
IS THERE ANY DAY OF MY CYCLE WHEN I’M LEAST LIKELY TO GET PREGNANT?
Yes. Your period is generally the ‘safest’ point in your cycle, and you are most fertile when you are ovulating, which is approximately day 14 of a regular 28-day cycle (your cycle starts on the first day of your period). However, sperm can live inside the vagina for up to five days, making the ‘safer’ window of small. Most people may experience irregularities in cycles due to physical or emotional stress. Hence, using hormonal birth control is a more reliable method.
Read up more on fertility awareness methods here.
With careful use and reading of the body’s signs of fertility (e.g. cervical mucus, cervix positioning, etc), it can be an effective method of birth control with a success rate ranging from 75%-97%. If you are not yet familiar with tracking your body’s signals, experts recommend a more reliable method like hormonal birth control.
The above does not apply if you are on a hormonal birth control method as your natural menstrual cycle is suppressed. As long as you have been using your birth control properly and consistently, you should be protected.
A good rule-of-thumb for users of most pill types* is “21/7”: taking at least 21 days of active pills and having no more than 7 hormone-free, or placebo days, in order to have full protection. Always refer to the pill package leaflet for more information.
HOW CAN I REMEMBER TO TAKE MY BIRTH CONTROL METHOD REGULARLY AND ON TIME?
A cursory Google search points to numerous smartphone apps, email and text reminder services. You can also put it somewhere noticeable so you don’t forget, or simply set a daily/weekly/monthly alarm on your device.
CAN I SKIP MY PERIOD ON THE BIRTH CONTROL PILL?
Yes. HBC users have been doing so safely for decades. There is no evidence that points to any health risks from skipping periods.
For information on how to do so for the pill, ring or patch, see here.
ARE THERE OTHER BENEFITS TO BEING ON BIRTH CONTROL?
Yes, it can treat heavy, irregular or painful periods, improve PMS symptoms and some gynaecological problems (e.g. fibroids, endometriosis). It can reduce the risk of ovarian and endometrial cancers.
Also, all pills can help with acne problems, and certain pill formulations (e.g. Diane-35) have been approved specifically for the treatment of acne. As acne can flare up according to an individual’s menstrual cycle, any hormonal method, by taking away those hormonal fluctuations, can potentially help with acne.
However, there is still no guarantee that it will improve any pre-existing condition as each individual’s body chemistry is unique and will react differently to different pills at different times. All hormonal methods can potentially help or worsen existing conditions. There is no way to know for sure until you have tried it. The age-old warning of sticking to it for 3-4 months before your body adjusts to the pill still applies.
It may also be the case that once you go off HBC, your body will go through a transition period as it adjusts to the hormone withdrawal, causing temporary side effects (e.g. acne, irregular periods, etc).
WHAT DO I DO IF I MISS A PILL?
Due to different pill specifications, it is best to refer to the pill package leaflet for specific instructions. Don’t have it on hand? Find it online on the manufacturer’s website.
General Guidelines:
If you missed 1 active (hormonal) pill or if you started a pack 1 day late:
- Take an active (hormonal) pill as soon as possible and then continue taking pills daily.
- Emergency contraception (or “the morning after pill”) is not needed. Additional contraceptive protection (such as condoms) is recommended for the next 7 days just to be safe.
If you missed 2 or more active (hormonal) pills or if you started a pack 2 or more days late:
- Take an active (hormonal) pill as soon as possible* and then continue taking pills daily. Depending on when you remember that you missed a pill(s), you may take 2 pills on the same day (one at the moment of remembering, and the other at the regular time) or even at the same time.
- Also, use condoms or abstain from sex until you have taken active (hormonal) pills for 7 days in a row.
- If you missed the pills in the third week, you should finish the active (hormonal) pills during your current pack and start a new pack the next day. You should not take the 7 inactive pills.
- If you missed the pills during the first week and had unprotected sex you should use emergency contraception for maximum protection, in addition to taking today’s active birth control pill.
If you missed any inactive (non-hormonal) pills:
- Discard the missed inactive (non-hormonal) pill(s) and then continue taking pills daily. As they contain no hormones, skipping the consumption of the placebo pills will have no unintended effect.
DOES DRINKING ALCOHOL, CONSUMING OTHER SUBSTANCES OR MEDICATIONS MAKE THE PILL LESS EFFECTIVE?
Intestinal absorption of the pill decreases when you are having a gastrointestinal infection (diarrhea or vomiting) or if you are on any broad-spectrum antibiotics.
According to the Faculty of Sexual & Reproductive Healthcare Clinical Guidance, the antibiotics rifampicin and rifabutin have been shown to interfere with the effectiveness of most hormonal contraceptives, though they don’t appear to reduce the effectiveness of Depo Provera shot or the Mirena IUD. The evidence for other antibiotics is inconclusive, so it’s best to discuss them with your doctor and/or to use a backup method for 7 days just in case.
Other known HBC drug interactions include anti-epilepsy medications, certain psychiatric medicines, some barbiturates and muscle relaxers, the antifungal griseofulvin, and anti-retrovirals used in HIV treatment.
There have been small studies showing that the use of the herb St. John’s Wort reduced HBC effectiveness. As for other herbs and supplements, check each product with a doctor before beginning treatment just to be safe.
There is no evidence to suggest that drinking alcohol decreases the efficacy of hormonal contraceptives. However, if, due these substances, you forget to take a pill or you vomit within an hour or two of taking it, that could interfere with the effectiveness of your HBC. <Reference>
I’VE READ REPORTS OF DEATH FROM CERTAIN PILLS. SHOULD I BE AFRAID?
Like all medications, HBC methods carry risks with them, including that of potentially fatal blood clots. . According to the New York Times, “The risk is highest for women who smoke or have a history of heart disease risk factors (such as high blood pressure or unhealthy cholesterol/lipid levels) or cardiac events. Women who have certain metabolic disorders, such as polycystic ovary syndrome (PCOS), are also at higher risk for heart-related complications associated with these pills. Women who have migraines may possibly be at increased risk for stroke and may need to consider progestin-only pills or other contraceptive methods in place of combination oral contraceptives.”
Pills like Yaz, Yasmin and others have generated controversy due to recent lawsuits resulting from women’s deaths while on the pill. The concern is that the third-generation progestins in those pills may be more likely to cause venous thromboembolism (blood clots) than others.
According to an FDA study, there appears to be an “ approximately 1.5-fold increase in the risk of blood clots for women who use drospirenone-containing birth control pills compared to users of other hormonal contraceptives.”
However, for low-risk users, the danger is still extremely small low overall. This table shows the risk per 100,000 users per year for two other third-generation progestins; the risk was about 23 in 100,000. (By comparison, the risk for venous thromboembolism (blood clots) in pregnancy is about 1 to 2 per 1,000.)
It is important for you to weigh these considerations for yourself and decide with your doctor if you should take these types of HBC.
Is your question still unanswered? Fear not. If talking to a doctor is not an option, there are plenty of online resources to help you.
For questions specific to birth control type (pill, condoms, patch, ring, IUD, etc), see here .
For questions on reproductive health in general, sex-positive forums like the online safe space VaginaPagina and Q&A library Go Ask Alice! offer a treasure trove of information and knowledge from experienced users.
Disclaimer: None of the above is meant to be substituted for medical advice/care. If in doubt about anything birth control or health-related, please see a doctor.