What Your Sex Ed Class Got Wrong About Birth Control

If you learned about birth control in sex ed class, you most likely learned about condoms and the pill. The condom slides gently over the banana (er, penis), and the pill is for girls to take every day and comes in a cute little compact case.

What you probably didn't learn—and what's very consequential for women—is that most hormonal birth control pills contain synthetic estrogen and progestin, which prevent your ovaries from releasing eggs.

We'll get to why that's significant in point three. But what definitely wasn't taught in many sex ed classes was that other options exist, such as intrauterine devices (IUDs), including a nonhormonal version, and the birth control implant.

"There are so many different forms of birth control, and you can find one that works for your specific body," said Jimanekia Eborn, a sex educator and sexual health expert in Los Angeles and host of the "Trauma Queen" podcast. "When young women do learn about birth control, they've oftentimes [been] prescribed a specific brand and not given options or varieties; specifically, talking about nonhormone versus hormone options."

It does make sense that the birth control pill is recommended first when teaching teenagers about safer sex. It's easy and pain-free to obtain (while IUD insertion can be quite painful), and it can help relieve certain side effects of ovulation, including cramping and heavy flows.

But young girls often aren't informed of the drawbacks.

"Hormones can cause a lot of different reactions in folks' bodies, and if they're unaware that they can use different birth control, they're stuck having to use the same one that may not be the right fit for them," Eborn said.

I didn't know much about the stages of the menstrual cycle until I was trying to get pregnant. That seems to be the case for most women, who almost certainly weren't taught about how the birth control pill impacts their cycle and how understanding that is key to getting pregnant. (It is also very helpful in preventing pregnancy.)

A quick overview. The menstrual cycle is made up of four phases: menstruation, the follicular phase, ovulation and the luteal phase. Menstruation is the shedding of the uterine lining. During the follicular phase, estrogen increases in preparation for an ovary to release an egg. Estrogen peaks just before ovulation, at which point an egg is released.

If sperm is present in the 24 hours after the egg is released, the egg may become fertilized, resulting in a possible pregnancy. (Lots of other things still have to go right for this to happen.)

If sperm is not present, we're back to menstruation. The uterine lining that built up as a cushion in which a fertilized egg might implant is then shed—and we get our period.

The menstrual cycle is what makes it possible for women to get pregnant, but only for about six days. These days are called the fertile window, and they happen in the five-ish days before we ovulate, the day of ovulation and the 24 to 48 hours afterward. While women are often taught that they can get pregnant at any time (even if it's less likely at certain times in their cycle), what this really means is that it's very easy to miscalculate your menstrual cycle and the timing of ovulation, especially when you're not taught the details.

Mary Spadoni, 38, from New York City, said sex education class gave her the impression that she would definitely get pregnant if she had unprotected sex.

"Imagine my surprise, and dismay, when, 25 years later, it took me four years and three rounds of IVF to have just one baby," Spadoni said.

Even when you are trying to get pregnant and timing sex during your fertile window, pregnancy is far from guaranteed.

"The chances are higher when you're younger, but generally speaking, we have about a 25 percent chance per menstrual cycle that pregnancy will occur," said Cary Dicken, M.D., from RMA Long Island IVF in New York. "Most patients I see who have trouble getting pregnant are concerned they're not timing it right. And they just don't know how to figure it out, because nobody ever teaches us."

Preventing teen pregnancy is an important goal of sex education classes. Only about 50 percent of girls who get pregnant during high school receive their diplomas, compared with 90 percent of those who do not get pregnant. They are more likely to have a low income into adulthood, and their children are more likely to face health, education and behavioral challenges.

But if sex education taught us how our cycle relates to when we can possibly get pregnant, we would also know when we cannot get pregnant. Understanding the menstrual cycle as it relates to fertility can also give us a better appreciation for the awesomeness of our bodies—even if getting a period (especially when you're a young girl) can be a real drag.

"You have that week of sugar pills, and that's when you get a bleed," said Dicken, of being on hormonal birth control. "Most people will say, 'Oh, I got my period.' But, in fact, when you're on hormonal birth control, it's not a period by definition."

Rather, bleeding while you're on the pill is technically withdrawal bleeding. While natural menstruation happens when the lining of your uterus has built up in preparation for possible pregnancy and then sheds, the blood you see while taking hormonal birth control is a result of the sudden absence of hormones.

This withdrawal bleeding, as opposed to natural menstruation, isn't necessarily a bad thing. For most women, the pill is perfectly safe and effective in preventing pregnancy. But since so few sex-ed classes explain ovulation alongside birth control, young girls don't learn how the pill works and how it impacts their natural cycle. This can be frustrating when, years later, they do wish to become pregnant and it's been many years since they've seen their natural cycle, which varies significantly person to person and sometimes month to month. We don't see our natural cycle while taking birth control, so we might not know if there is something abnormal about it.

"[Hormonal birth control] could hide an ovulatory problem," Dicken said, though she emphasized that the pill has no impact on your future ability to have babies. "If you start the pill when you're relatively young, maybe in your teens, and you take it until you want to start a family, and then you come off the pill and you don't get a period, that isn't normal. And it had been masked for all those years."

This was the case for Spadoni, who had undiagnosed polycystic ovary syndrome (PCOS) until she was trying to get pregnant, because the pill had always given her a very regular cycle.

"I just never thought about the potential impact of taking hormonal birth control month after month during my, theoretically, most fertile years," Spadoni said. "Had I known that a nonhormonal IUD was even an option, I certainly would have given it some serious consideration."

The hormones in birth control can impact our health beyond our period, too.

"For some, it can change the way their body performs, such as added hair growth," Eborn said. "For some individuals, it may actually make their periods worse—it can lead to longer periods, it may even lead to more painful periods."

What birth control doesn't do, however, is impact future fertility, which Dicken said is another common misconception she sees with patients. If a woman's cycle isn't regular a month or two after stopping birth control, they blame it on the pill and think they need to "get it out of their system." But Dicken said that's not the case.

"The female body is very smart, and it knows when those [artificial] hormones are no longer detected in the body," Dicken said.

So if your period isn't regular after getting off the pill, it's important to tell your doctor.

Ryan's sex education at her Catholic high school took place over two days, just one hour at a time, in religion class. Ryan said the focus was on the Christian lifestyle and natural family planning, which requires abstinence until marriage, after which the point of sex is conception.

Condoms and the pill were not covered in Ryan's sex education class, but she was taught that if she became pregnant, it was her fault.

"There was no responsibility for the man, because 'men just want to have a lot of sex and that's just how they are,'" she said.

So even though Ryan was being taught abstinence, the onus of maintaining that abstinence was put on the girls in the room.

"The double standard was and still is enormous," Ryan said.

The weight of pregnancy—especially unplanned, teenage pregnancy—falls disproportionately on women, too. They are the ones who will carry the baby, whose bodies and hormones will change drastically, who will deliver the baby into the world. But it takes two to get there.

In the National Survey of Reproductive and Contraceptive Knowledge, only 45 percent of young boys said they are committed to avoiding pregnancy. It's pretty difficult to find any information on the impact of teenage pregnancy on boys compared to girls. But a 2011 study out of Yale University did find that graduation rates decreased by 15 percentage points for boys who became fathers as teens.

Many sex education classes are still divided between girls and boys. Girls receive one education and boys receive another. Not only does this prevent discussion between the sexes, it ostracizes students who do not identify with their assigned sex or the gender binary.

"We have an attitude in society that vulva owners will take responsibility for contraception," said Isabelle Uren, a sex expert based in Denmark and writer at BedBible, a source for sex information.

When it comes to hormonal birth control, which so many young women end up taking, Uren said it's important for young boys to understand how that works, too.

"Often, their partners don't fully understand the full effect that birth control methods can have on their overall well-being," Uren said.

Birth control is so much more than condoms and pills. It's an opportunity to understand our bodies, our desires and each other—if only sex education found more ways to connect the dots.