TABLE OF CONTENTS

How can I start receiving birth control with Plume?

Message your Care Team in Spruce and let them know you want to set up an appointment with your provider. You will first talk with your provider about what birth control options are the best fit for you. Your provider will answer any further questions you have. Together, you will both come up with a method that fits your needs. Your provider will then send a prescription to a local pharmacy for you, should you choose to start medication.


What is hormonal birth control? 

Hormonal birth control consists of medications that contain progestin or a combination of estrogen and progestin. Folks with a uterus and/or ovaries can use hormonal contraception for a few reasons:

  • Stop uterine bleeding

  • Reduce heavy uterine bleeding

  • Manage the symptoms that may come with monthly bleeding (cramping, bloating)

  • Help prevent and reduce acne

  • Protect against pregnancy 


Types of birth control

How to choose

The following questions may be helpful to consider when exploring which birth control method is best for you:

  • If you used hormonal contraception before, what did you use? Did you like it? 

  • How often do you want to be involved in delivering your contraceptive method? Ex: pills require daily use, in comparison to a method like the depo injection which only needs to be injected every 3 months. 

  • Do you want to experience monthly menses?

  • Would you prefer to have as minimal bleeding as possible?

  • Considerations for folks on gender affirming hormone therapy (GAHT) –

    • Testosterone is not  birth control. People on T will often stop getting a period. However, if ovaries and a uterus are still present, the ovaries can continue to ovulate and release eggs.  This means a person CAN STILL BECOME PREGNANT

    • Hormonal birth control and testosterone can be used together. Both medications will still be effective. The small amount of estrogen and progesterone in hormonal contraception will not impact how testosterone impacts your body.


You may also find this birth control chart by Planned Parenthood helpful to learn more and explore your options. 


Pills

Pills need to be taken every day, at the same time of day. The last row of pills in the pack are usually a different color than the rest and typically do not contain medication. They are called placebo pills. This is when monthly bleeding occurs. You do have the option to skip that week and start a new pack. Keep in mind that with continuous use, irregular bleeding can occur at around 3 months. There are combined pills (containing estradiol and progestin) and progestin-only pills (POPs).  

If you miss a dose the pill will be less effective.  For POPs, this is especially true. POPs must be taken at the same time every day to be effective. Pills are a great option for folks who don’t mind taking a daily medication.


Patches 

Patches are a combination of estradiol and progestin and are used once per week for three weeks. During the fourth week, no patch is worn and monthly bleeding occurs. You have the option to use the patch continuously to avoid monthly bleeding; this is safe to do. The patch can be super helpful for folks already on a weekly injection schedule. Some people have trouble ensuring the patch sticks to their skin and some people have skin irritation from the adhesive.


Vaginal rings

Vaginal rings are also a combination of estradiol and progestin. The ring is inserted vaginally by the patient. It is replaced every 3 weeks with one week in-between, this is when monthly bleeding will occur. You have the option to replace the ring continuously (without the one week gap), however, this can sometimes cause irregular bleeding (breakthrough bleeding). Keep in For some people, insertion can be dysphoria-inducing. One benefit of the ring is the potential to help manage vaginal dryness/atrophy that can be common for folks on testosterone. 


IUDS & implants

An intrauterine device (IUD) is a T-shaped piece of plastic, about the size of a quarter, that is placed inside the uterus to prevent pregnancy. Two types of IUDs are available: one is covered with copper, and the other releases the hormone progestin. An IUD is placed during a procedure that involves an in-person visit with a clinician. There can be  discomfort associated with the insertion. Some people also notice pelvic irritation or discomfort after the IUD is inserted. Please note that this form of birth control is not available with Plume. 


A birth control implant is a very small, flexible rod inserted under the skin of the upper arm.. It is typically not visible. Sometimes there is a very small scar where it was inserted..  An implant requires an in-person visit for a clinician to insert the rod. The implant is FDA approved to stay in place for 3 years, however the latest research shows it is effective for up to 5 years. Please note that this form of birth control is not available with Plume. 


Injections 

The depo injection is a progestin only method that can be injected once every 3 months. Injections are available through the subcutaneous and intramuscular route. Both routes can be administered in-person, by a healthcare provider. Subcutaneous depo can be self-injected and is available at Plume. 


Internal condoms 

An internal condom is a pouch that's inserted in the vagina before sex for birth control. It works like other condoms, except that it's worn on the inside. It can also be used to prevent sexually transmitted infection and can be inserted both inside the vagina and anus before sex. This does not require a prescription.


Risks or side effects

Commonly experienced side effects derived from estrogen-based birth control

  • Nausea, 

  • Chest/breast tenderness, 

  • Bloating, 

  • Headaches 

  • Irregular bleeding 

  • We don’t have enough data to suggest any negative impact on mood and sex drive


Commonly experiences side effects derived from progesterone based birth control:

  • Acne 

  • Irregular bleeding 


I am on testosterone, can I still get pregnant?

It is important to note that although testosterone can lower the chances of becoming pregnant, it’s still possible to become pregnant on testosterone. A person with a uterus having receptive sex with a sperm-producing partner can become pregnant at any point, even if they are not getting a period. 


Who is not eligible for hormonal birth control?

  • Anyone who is pregnant or might be pregnant

  • Any patient with cancer of breast/chest tissue

  • Folks with or who have had a history of Lupus with antiphospholipid antibodies


For combined estrogen and progestin medications:

  • History of migraines with aura (aura is like a warning sign that let’s you know you’re about to have a migraine) 

  • Elevated blood pressure readings

  • Anyone with estrogen derived cancer

  • History of a blood clot in arms/legs/lungs

  • Decompensated cirrhosis of the liver

  • Clotting mutations (a genetic tendency to form blood clots)

  • Anyone 35 years old or older who smokes cigarettes and/or vapes


This is not a complete list of eligibility criteria. For more detailed information on birth control eligibility, you may review the US Medical Eligibility Criteria for Contraceptive Use here or speak directly with your Plume provider.


Additional resources