Oral Contraception

Oral contraception, usually called the birth control pill, is a tablet taken daily to avoid pregnancy. Most pills used in Canada contain two hormones, an estrogen and a progestin, while progestin-only pills contain one. Pills are also prescribed for other reasons, including heavy or painful periods, premenstrual symptoms and acne. This is a treatment rather than a condition.

What oral contraception is, and what it is not

It is not a single product. Formulations differ in the type and amount of hormone, in how the hormone-free days are arranged, and in whether estrogen is included at all. Progestin-only pills exist for people for whom estrogen-containing methods are not suitable. Because the products differ, an experience with one pill does not predict the experience with another.

It is also not only about pregnancy. Canadian sources describe hormonal contraception being used in the management of heavy or painful periods, endometriosis, premenstrual symptoms including PMDD, and acne. And it is not the only method: Statistics Canada figures show the pill is one of several methods Canadians use, with condoms more commonly reported and permanent methods and IUDs each accounting for a substantial share.

What the categories are, and who uses them in Canada

• Combined pills containing an estrogen and a progestin, which accounted for 98.6% of use among Canadian users in the Statistics Canada analysis
• Progestin-only pills, used when estrogen-containing methods are not suitable
• Used most often by younger people: 50.3% of contraceptive users aged 15 to 24 used the pill, compared with 10.6% of those aged 35 to 49
• Often used for years at a time, with 67.5% of current users in the Statistics Canada analysis having used them for four years or more
• Also prescribed for heavy or painful periods
• Also used in the management of premenstrual symptoms, including drospirenone-containing formulations for PMDD, and as one option in endometriosis management
• Also prescribed for acne in some cases

What people want from contraception changes across a lifetime, and so does the method that fits.

How the decision is made with a clinician

Part of the conversation is about facts of your history that cannot be changed:

• A personal or family history of blood clots, stroke or certain clotting disorders, which affects whether estrogen-containing pills are considered
• Migraine with aura, which changes which categories of contraception are discussed
• A personal history of breast cancer, or certain liver conditions
• Your age, which is weighed together with other factors
• Some medications, including certain anticonvulsants and antiretrovirals, that interact with hormonal contraception

Other parts can be reviewed, and often worked on with support from a health care team:

• Smoking, which is weighed together with age in the assessment
• Blood pressure and other cardiovascular risk factors a clinician goes through before prescribing

Cost is part of the picture too. British Columbia became the first province to provide universal free prescription contraception on 1 April 2023, and in the first eight months about 188,000 people received at least one free contraceptive, including more than 123,000 who received hormonal pills. The province noted that pills had previously cost as much as $300 a year. Elsewhere, coverage depends on the provincial or territorial plan and on any private plan you have.

What the assessment involves in Canada

There is no test that decides whether to use oral contraception. A family doctor, nurse practitioner, or in some provinces a pharmacist, takes a medical and family history, checks your blood pressure, and reviews migraine history, smoking, current medications and any clotting or cardiovascular history. Together you go through what matters most to you, including bleeding patterns, cost and coverage, ease of use, and whether you want a daily method or a longer-acting one.

Methods and day-to-day management

Clinical research for Oral Contraception is enrolling. See the current studies ↓

Oral contraception is one option among several available in Canada. Depending on your history and what matters to you, a health care team may discuss:

• Combined oral contraceptives containing an estrogen and a progestin, in a range of formulations and hormone-free interval schedules
• Progestin-only pills, used when estrogen-containing methods are not suitable
• Other hormonal methods available in Canada, including the vaginal ring, patch, injection, implant and hormonal IUD
• Non-hormonal methods, including copper IUDs, condoms and other barrier methods, and permanent methods such as vasectomy and tubal ligation
• Emergency contraception, available in Canada as pills or as a copper IUD inserted by a clinician

What suits one person will not suit another, and the method that fits at 20 may not be the one that fits at 40. Which of these applies to you, if any, is a decision for you and your own clinician, and this page is not a recommendation about any of them.

When to talk to a doctor

• Book an appointment to discuss options, or to review your current method if bleeding patterns, mood or side effects are bothering you.
• Contact a clinician or pharmacist quickly if you have missed pills and had sex, since emergency contraception is time-sensitive.
• Seek emergency care for sudden chest pain or shortness of breath, one-sided leg swelling or pain, a sudden severe headache, changes in vision or speech, or weakness or numbness on one side of the body.

Why clinical research matters for contraception

Open questions include how different progestins and estrogen amounts compare on bleeding patterns, mood and clotting risk, why side effect experiences differ so much between individuals, and how removing cost changes uptake and continuation. Statistics Canada notes that current oral contraceptive use is lower among racialized and Indigenous women than among non-racialized and non-Indigenous women, and the reasons for that difference are not established. The Canadian figures on this page also come from survey cycles running from 2007 to 2019, so they describe a period that has already ended. Research now under way includes trials of new hormonal and non-hormonal contraceptive compounds including methods for men, studies of over-the-counter and pharmacist-led access, and evaluations of universal coverage programs such as British Columbia\’s.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up your current method, and no one can tell in advance whether a study will help you personally.

Learn more from Canadian sources

• Sex and U, Society of Obstetricians and Gynaecologists of Canada
• Action Canada for Sexual Health and Rights: Access Line and service provider directory
• Statistics Canada: oral contraceptive use in Canada
• BC PharmaCare: free prescription contraception