Dear Alice,

I was wondering if it is possible to take the pills on the month I needed it. My boyfriend and I have a long distance relationship. We only meet once between three to four months' time. So I was thinking of taking birth control pills only on the months we meet. Is that effective method for preventing pregnancy? It's just that we both prefer not to use a condom as it feels uncomfortable.

Dear Reader,

Reuniting with a long distance partner after months apart can be such a magical time! To help you focus on them, and not on an unintended pregnancy, it’s best to take your birth control pills every day, even if you're not seeing your boyfriend at the time. Skipping your pills or taking them inconsistently reduces their effectiveness for pregnancy prevention. If that isn’t preferable or doesn’t seem feasible, you may wish to speak with your health care provider about other hormonal and non-hormonal contraceptive options (more on those in a bit). Though you’ve expressed disinterest and discomfort with condoms, keep in mind that they’re the only contraceptives that can also reduce the risk for sexually transmitted infections (STIs). If STIs are a concern for you and your partner, discussing your respective risk for them — such as how many other partners you’ve both had and how often you’ve used protection — and getting tested for any potential infections can further inform whether to use or not use condoms in the future (alone or with other contraceptive methods).

Birth control pills work by keeping hormone levels at a certain level. To maintain maximum effectiveness, people may wish to skip or discontinue using them altogether because of infrequent sex, cost, change in health insurance status, and side effects, among other reasons. If this is the case, it may be best to explore alternate contraceptive choices to ensure effective pregnancy prevention. Luckily, there are a number of options available that may better suit your needs, without compromising your comfort and sensation. As a reminder, none of these options protect against STIs.

Options that require a visit to a health care provider (and sometimes a prescription) include:

  • Intrauterine device (IUD): An IUD is a small, T-shaped device that's inserted into the uterus. Depending on the type, it can be effective for three to twelve years and requires minimal user maintenance. In fact, it only needs to be checked once a month by checking the strings located near the cervix. This method is roughly 99 percent effective at preventing pregnancy.
  • Contraceptive implant: This device, resembling the size of a matchstick, is implanted in the upper arm by a health care provider. It remains in place for up to three years (but can be removed by an HCP at any time) and is about 99 percent effective at preventing pregnancy.
  • Contraceptive patch: This method is used each week for the first three weeks of the month (one patch per week), and the fourth week of the month doesn’t require a patch at all. When used correctly and consistently, it’s 99 percent effective in preventing pregnancy.
  • Contraceptive injection: This injectable birth control method is only needed once every three months. Because this method is administered by a health care professional (limiting the risk of user error), it can be upwards of 99 percent effective in preventing pregnancy. The key is to schedule the next shot at the three month mark.
  • Vaginal ring: The contraceptive ring is inserted into the vagina and remains there for three weeks out of the month and then must be removed for the fourth week. When used correctly and consistently, it’s 99 percent effective in preventing pregnancy.
  • Diaphragms or cervical caps with spermicide: The diaphragm and cervical cap are similar, but have a few key distinctions. It’s recommended that spermicide be used with each. As far as effectiveness goes, the diaphragm is 94 percent effective and the cervical cap is about 86 percent effective at preventing pregnancy when used correctly and consistently every time you have sex.

Interested in skipping the doctor’s visit or prefer to do-it-yourself? Check out these over-the-counter (OTC) options:

  • Contraceptive sponge: The sponge is inserted before sex and protects against pregnancy for up to 24 hours. If used correctly and consistently each time, the sponge can be 91 percent effective in preventing pregnancy.
  • Vaginal spermicide: This comes in various forms (cream, gel, suppositories, films, and foams), and may also act as a lubricant. This method is inserted into the vagina prior to sex and is between 72 to 82 percent effective at preventing pregnancy.
  • Fertility awareness: The idea behind fertility awareness is to observe changes in body temperature and vaginal discharge, in order to track a person's most fertile days. To reduce the risk of pregnancy, sex is to be avoided on days when these factors indicate fertility. This method typically requires the use of a basal thermometer and a commitment to daily measurements and observations. If used correctly and consistently, this method is about 76 percent effective.
  • Withdrawal: Frequently called pulling out, this method is convenient and free, but it's not as effective as most other methods. There may be contact with pre-ejaculatory fluid (which may contain sperm) and it relies on accuracy and self-control in order to pull out in time. With typical use, this method is about 78 percent effective.

Ultimately, choosing a birth control method is an individual decision based on how you prioritize factors such as price, convenience, comfort, and more. For more guidance in making this decision (and potentially a prescription, if needed), it’s recommended that you talk with your health care provider who will be able to answer your specific questions and help determine the method that’s right for you. You can also check out the Contraception section of the Go Ask Alice! Sexual & Reproductive Health archives to learn more.

Here’s to many more intimate and safe visits with your boyfriend!

Alice!

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