Reproductive health is caring for the body’s reproductive processes throughout every stage of life. It’s about having a pleasurable and safer sex life, along with the freedom to decide if, when, and how often to have children.
Getting information about your options for birth control or maintaining a healthy lifestyle to ensure the best chance of getting pregnant, are both a part of reproductive health.
Part of a healthy and enjoyable sex life is the freedom to choose if and when to become pregnant. If you're sexually active, it's important to take steps to avoid unintended pregnancy by using effective birth control. There are various birth control options, and it's important to learn more and discuss them with your health care provider or a nurse at a sexual health clinic. This way, you can choose the birth control method that works best for your body, your relationships, and your lifestyle.
Know your options
There are hormonal and non-hormonal contraceptives, so you'll want to consider things like effectiveness, potential side-effects, and frequency of use when selecting a method of birth control. Birth control methods are less effective if used inconsistently or incorrectly, so it's important to consider your ability to stick to a regimen of use.
The most effective methods of birth control are sterilization and intrauterine devices (IUDs). Sterilization (vasectomy or tubal ligation) is usually permanent, but IUDs are reversible and highly effective once correctly in place.
Hormone based methods including "the pill", patches, vaginal rings, and "the shot" (injections) are very effective when used correctly. Physical barriers such as condoms, diaphragms and birth control sponges, and natural methods are less effective. The least effective birth control methods are spermicides and withdrawal by the male before ejaculation.
Remember that most methods of birth control do not protect against STIs. Therefore, it’s important to use a condom to protect against STIs.
Containing one hormone (progestin), the IUD is a small "T-shaped" piece of plastic with a band around it that gets inserted into your uterus by a health care provider. It can be left in for up to 5 years, and can prevent more than 99% of unintended pregnancies.
Possible side effects are irregular periods for the first few months, lower abdominal pain, weight gain, moodiness, acne, breast tenderness, and headaches. Ask your health care provider about any risks or side effects.
Commonly known as "the pill", it contains the hormones estrogen and progestin and is prescribed by your health care provider. You take the pill every day at the same time. If you're over 35 and smoke, or have a history of blood clots or breast cancer, your health care provider may advise against the pill. Based on typical use, the pill is 91% effective.
Referred to as "the mini-pill", it contains only one hormone (progestin), so may be a good option for women who cannot take estrogen. Prescribed by your health care provider, you take the mini-pill at the same time each day. Based on typical use, the mini-pill is 91% effective.
Often called "the shot", it contains the hormone progestin. Every three months, your health care provider gives you a shot in the buttocks or arm. Repeat injections need to be done on time. Based on typical use, the shot is 94% effective.
Worn on your skin, the patch releases estrogen and progestin into the bloodstream. Prescribed by your health care provider, you have to change the patch once a week for three weeks, placing it in on the lower abdomen, buttocks or upper body (but not the breasts). During the fourth week you do not wear it, so you can have a period. Based on typical use, the patch is 91% effective (but may be less effective for those who weigh more than 198 pounds).
Prescribed by your health care provider, you insert the ring into your vagina and it releases the hormones estrogen and progestin. Worn for three weeks, you remove it for the week you have your period, and then put in a new ring. Based on typical use, the ring is 91% effective.
Non-hormonal and barrier methods
The IUD is a small "T-shaped" piece of plastic with copper coil around it and contains no hormones. It is inserted into your uterus by a health care provider and can be left in for up to 5 years and requires no maintenance. The IUD can prevent more than 99% of unintended pregnancies. Possible side effects include heavier periods and cramping. Ask your health care provider about any risks or side effects.
Worn on the penis, condoms prevent sperm from entering the vagina. Commonly made of latex, condoms help prevent pregnancy, as well as protect you against HIV and other STIs. Available without a prescription, condoms must be put on before intercourse and can only be used once. "Natural" or "lambskin" condoms may not be effective protection against STIs, but they also help prevent pregnancy. Based on typical use, condoms are 82% effective. They are also highly effective in preventing sexual transmission of HIV and STIs.
Worn inside the vagina, female condoms prevent sperm from entering the body, and protect against HIV and other STIs. They can be inserted up to 8 hours before sex, and are available without a prescription at pharmacies or at sexual health clinics (free of charge). Based on typical use, female condoms are 79% effective. They are also highly effective in preventing sexual transmission of HIV and STIs.
Shaped like a shallow or thimble-shaped cup and placed inside the vagina, diaphragms/caps cover the cervix to block sperm. Used with spermicide and inserted before sex, you must see your health care provider for a proper fitting because they come in different sizes. Based on typical use, diaphragms are 88% effective.
Placed into the vagina before sex, spermicide kills sperm to prevent pregnancy. Available at pharmacies in foam, gel, film, suppository or tablet forms, you must leave spermicide in place for 6–8 hours after sex. Spermicides can be used with male condoms and diaphragms/caps for additional protection. This method is among the least effective methods for prevention of pregnancy. If used properly, spermicide is approximately 72% effective.
If you have a regular menstrual cycle, you have approximately nine fertile days each month. If you avoid having sex or use a condom or diaphragm on these days, it can help prevent against unintended pregnancy. Fertility patterns vary among women, so you will need to develop an understanding of your own before attempting to use this method of birth control. This method is among the least effective methods for prevention of pregnancy and is approximately 76% effective.
Permanent methods of birth control
Sterilization (vasectomy for men and tubal ligation for women) is a permanent, safe, and highly effective form of birth control for people who are certain that pregnancy is not something they want. However, sterilization can be permanent, so it's important to discuss it with your health care provider to ensure it's the right option for you.
Emergency birth control
Commonly referred to as "the morning-after pill", it can be used up to 72 hours after having sex without a condom or in the event of a contraception failure, such as missed birth control pills or a condom breaking. Emergency contraception is NOT a regular method of birth control.
Women may need to use emergency contraception after having sex if:
- The condom broke
- No birth control was used
- Two or more birth control pills were missed consecutively
- Late for shot or diaphragm slipped
- Sex was forced
Available over-the-counter in Canada, emergency contraception can reduce the risk of unintended pregnancy by approximately 75%, and is most effective the sooner it's taken after having sex without using any form of birth control. Common side effects are nausea and vomiting, irregular vaginal bleeding, fatigue, headache, dizziness, and breast tenderness.
Emergency contraception will NOT affect an established pregnancy. If you think you may be pregnant, see your health care provider.
You're in this together
No matter what type of birth control you choose, you and your sexual partner have made the decision to engage in sex together, so it's important you discuss birth control openly and honestly to ensure you both feel comfortable, safe, and aligned in your choices.
The following resources may provide additional information about birth control:
Fertility and you
Pregnancy is based on a number of complex factors. While some people can become pregnant without much difficulty, for others, the process is not so easy. About 1 in 6 couples will experience infertility at some point in their lives.
There are several reasons why people may experience difficulties conceiving:
- Age is a significant factor, as fertility starts to decline around the age of 30 and this process speeds up around the age of 35
- Lifestyle factors including obesity, smoking, alcohol use and sexually transmitted infections may also impact your ability to become pregnant
Understanding these factors can help you make informed choices about when to start a family, how to improve your chances of getting pregnant and when to seek help with fertility.
Fertility - the ability to become pregnant. If you and your partner are trying to get pregnant, understanding fertility can be an important step to increasing your likelihood of getting pregnant.
Infertility - the inability to become pregnant can be due to many factors. In some cases, medical treatments may help. A good place to start is having a conversation with your health care provider.
Getting the timing right
When you're trying to become pregnant, having sex without using any form of birth control two or three times a week during the fertile period in the menstrual cycle is key. For healthy couples wanting to conceive, understanding how this fertile period works is more important than constantly having sex.
Figuring out when to have sex can be important when trying to become pregnant. A person with a regular 28-day cycle begins ovulating 14 days before their next period. Many people believe that it's best to have sex once ovulation begins, but evidence shows that starting to have sex at this point may be too late. Health care providers recommend having sex, every other day, starting 3 days before ovulation begins.
For people who do not have a 28-day cycle, there are a few things you can do to determine when you're ovulating.
- Check for a rise in basal body temperature (your resting temperature first thing in the morning, before rising, moving or eating). This could be a sign that ovulation has occurred. After a few months of daily checks, a pattern may emerge.
- Use an ovulation predictor kit. This may be more expensive than tracking your temperature, but it may provide a more accurate indication of when your ovary is about to release an egg. Kits can be purchased at a pharmacy.
- Check for cervical mucus. This is another sign of imminent ovulation. When a person is about to ovulate, it produces larger amounts of thin, clear cervical mucus. Its presence marks a potential fertile period.
To learn more:
- Talk to your health care provider
- Use this ovulation calendar to track your fertile times
Lifestyle choices may impact a person's fertility. Following these tips for better health - before you get pregnant and throughout your pregnancy - may increase your chances of a successful pregnancy.
For men and women
- Follow a balanced diet
- Maintain a healthy weight
- Exercise regularly
- Manage your stress
- Avoid drinking alcohol, smoking and other drugs (e.g., marijuana, opioids, homeopathic remedies, etc.)
For women only
- Take folic acid supplements. This reduces the risk of neural tube defects in an embryo. Talk to your health care provider about recommended doses.
- Make sure your vaccinations are up to date for illnesses such as chickenpox, German measles (rubella) and hepatitis B. Read more now about how vaccinations can protect unborn babies.
A healthy lifestyle will benefit not only you and your partner, but your baby as well.
To learn more, check out The Sensible Guide to a Healthy Pregnancy
If you are trying to get pregnant, consider risk factors that may contribute to infertility.
Age is one of the main causes of infertility. Women start becoming less fertile around age 30 and fertility in women begins to decline rapidly around age 35. By age 40, women have a 5% chance of getting pregnant with their own eggs. The risk of miscarriage also rises as a woman ages. This is thought to be due to an increase in chromosomal abnormalities in the embryo.
Men's fertility also declines with age, although at a slower rate than women's.
Smoking reduces fertility rates in men and women. In men, smoking reduces the number of sperm and mobility of the sperm. In women, smoking affects the reproductive system and raises the risk of miscarriage. Smoking may work against the benefits of fertility treatments. Smoking can also contribute to premature or low birth weight babies.
If you need help quitting, reach out.
When it comes to drinking, there is no safe level of alcohol during conception or pregnancy. Drinking alcohol:
- may make it harder to get pregnant
- may increase the risk of miscarriage
- increases the risk of birth defects
Weight can impact fertility if:
- you are inactive and overweight
- the woman is underweight due to an eating disorder or a very low-calorie diet
For men, being overweight can result in lower sperm counts. Overweight women can also have medical problems during pregnancy.
Moderate exercise of about an hour a day will help you maintain a healthy weight. It will also improve your overall fitness.
If you need help to achieve a healthy weight before trying to get pregnant, talk to your health care provider.
Research shows that female athletes whose sports are associated with having a low body weight will have a harder time getting pregnant. This includes long distance runners and gymnasts, for example. Some of these women may experience ovulation and menstrual disruptions because of their extreme training.
Sexually transmitted infections (STIs)
Some STIs can cause infertility. Chlamydia, for example, can harm the fallopian tubes in women. It can also cause swelling and tenderness of the scrotum in men. Before trying to get pregnant, consider getting tested for STIs. Talk to your health care provider for more information.
Common causes of infertility in women
- Ovulation issues that prevent an egg from being released
- Poor egg quality, including eggs that are damaged
- Polycystic Ovarian Syndrome (follicles in ovaries that don't develop into eggs)
- Blocked fallopian tubes that prevent sperm from reaching the egg
- Endometriosis - when cells from the lining of the women's uterus grow in other areas of her body, resulting in inflammation and bleeding that may lead to scarring of the fallopian tubes or interference with implantation.
Common causes of infertility in men
- Problems having an erection or ejaculation
- Low sperm count (which may be due to blockages that prevent sperm from being ejaculated or increased temperature in the testes that affects the number of sperm produced)
- Irregular sperm shape or movement
Fertility treatments may help people who have experienced infertility become pregnant. You can learn about the options available, for example, medicines, surgeries or assisted conception, through discussions with your health care provider.
Talk to your health care provider if you have had frequent sex without any form of birth control and haven't been able to get pregnant. And if you:
- are 35 or under and tried for a year
- are over 35 and tried for 6 months
- do not have a regular period, and have tried for 6 months
Your health care provider can discuss diagnosis and medical treatment options with you.
There are three categories of medical treatment options for both men and women, depending on what is causing the infertility:
- Assisted conception
The option that's right for you will depend on age, preference and medical history. As always, you should discuss these matters with your health care provider.
Trying to get pregnant can be a stressful time. You may feel that your friends and family are not able to offer you enough support. If you need more support, talk to your health care provider about counseling or joining a support group in your area.
For additional information on pre-pregnancy (the time before and between pregnancies), visit OMama.
Situations may arise where you may consider having an abortion. This decision can be difficult and complex, so it's important to get accurate information about abortion services and care.
More about abortion services
An abortion is a safe medical procedure that ends a pregnancy. Abortion services are legal in Canada and available to anyone over 12 years old. There are two types of abortion methods:
- Medical abortion involves the use of pills to end a pregnancy and can be done up to 10 weeks after your last menstrual period.
- Surgical abortion ends a pregnancy by surgically removing pregnancy tissue from the uterus. It can be done for any pregnancy starting at six weeks after the first day of your last menstrual period, through to 25 weeks.
Both methods are covered by OHIP in Ontario.