In a recent Healthful Woman episode, “Contraception / Birth Control,” host Dr. Nathan Fox speaks with Dr. Stephanie Lam, an OB-GYN who counsels patients across every stage of life, from teenagers to women in perimenopause. Dr. Lam walks through how she narrows down the dozens of contraceptive options out there into the right fit for each individual patient.
Starting the Conversation, Even With Teens
Dr. Lam brings up birth control at most visits, not just when a patient asks. That includes younger patients, where she involves a parent or guardian but doesn’t shy away from direct questions. “I do not believe in the taboo of not talking about sexuality,” she says. Since many forms of birth control don’t protect against sexually transmitted infections, she makes sure patients understand that distinction early, even if they came in only for heavy or painful periods.
Sorting Through the Options: Hormonal or Not
With so many contraceptive choices available, Dr. Lam starts every conversation the same way: hormonal or non-hormonal, and how long the patient wants protection to last. “There’s no two forms of birth control that are right for the same person,” she says. From there, she narrows things down by age, symptoms, and whether someone needs a short-term solution or something meant to last for years, like an IUD.
The Least Effective Methods
Not every method patients ask about performs equally well. Withdrawal, or the “pull and pray” method as Dr. Lam calls it, comes in well under 75% effective, since pre-ejaculate alone can lead to pregnancy. The rhythm method fares only slightly better and depends heavily on a predictable cycle. Over-the-counter spermicides, used alone, still carry a failure rate of around 18 out of 100, though they work better paired with a barrier method like a diaphragm.
Barrier Methods and the One That Also Fights STIs
The diaphragm has seen a resurgence among patients who want to avoid hormones entirely, now available in a one-size-fits-most version rather than the custom-fitted diaphragms of decades past. But Dr. Lam is clear that it only blocks sperm, not infection. Condoms are the exception: “It is the number one form of birth control that will decrease the risk of transmission for sexually transmitted diseases, and is the gold standard for that,” she says, with effectiveness that climbs close to 95% with correct use.
The Pill Isn’t One-Size-Fits-All
Birth control pills work by preventing ovulation, but the countless brands on the market differ mainly in estrogen dose and progesterone type, a combination that explains why the exact same pill can feel completely different from one patient to the next. “I could give you the same pill to 10 different women, and two will say they love it, three will say they’re fine with it, two will say that they hate it,” Dr. Lam says. Her advice for anyone starting a new pill: give it two to three months before deciding it’s not right, since there are almost always other formulations left to try.
The Most Effective Options
For patients who want the lowest failure rates, Dr. Lam points to IUDs, hormonal implants like Nexplanon, and sterilization, all far more effective than pills, patches, or barrier methods, though best suited to patients thinking longer term rather than a few months at a time.
Listen to the Full Episode
To hear Dr. Lam and Dr. Fox go through the full range of contraceptive options in detail, listen to “Contraception / Birth Control” on the Healthful Woman podcast. If you’d like to talk through your own options, Carnegie Women’s Health offers family planning services and GYN services including in-office IUD insertion. You can request an appointment with our team any time.
Carnegie Women’s Health blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!
