Dr. Costescu is one of Canada’s leading contraception experts. He loves birth control so much it’s his Twitter handle: @BirthControlDoc.
Whether it’s an appointment for an IUD placement, Implant insertion, or finding the right contraceptive method based on your medical history, you’ve come to the right place!
Complex Contraception Finding the Right Birth Control
Finding the right birth control method can be a bit of a game, finding the safest method that meets as many “must have” and “ideal” features as possible.
As a contraceptive subspecialist, Dr. Costescu will review your medical history to determine if there are any reasons a specific method should or should not be used. He will go over the risks and benefits of the methods you’d like to know more about, and together you will come to a decision.
Sometimes, he may recommend a method that another doctor, nurse, or pharmacist has discouraged. Most birth control options are safer than people, even other clinicians, think. Also, with time, evidence changes that change whether a method is safer or less safe than previously thought. Rest assured that we will use the best available evidence to help you choose. It is important that you are comfortable with whatever method we choose, otherwise, you won’t use it.
If we decide that an IUD or Implant is the right option, you may be given the option to run to the pharmacy and have it placed the same day – it is completely optional, but it may save you a second trip to the doctor’s office.
And sometimes the right option for you is a permanent solution. Dr. Costescu offers tubal ligation (tubal removal) surgery for people who want child-free living and to those with children who want permanent contraception. It’s your body and your right.
IUD’s Intrauterine Contraception
Intrauterine Devices, or IUDs, consist of small plastic “T”s (about an inch by 1.5 inches in size) that contain either copper (drug-free) or progestin hormone (the safer hormone in a birth control pill). These are inserted in the office and provide birth control for 5, 7, or 10+ years depending on the one you choose.
Copper IUDs are a great option for patients who want completely drug-free birth control that is more effective than the pill. It is also a great option for people who like having monthly bleeding, either for reassurance or beliefs. Copper IUD users can expect an extra 0.5-2 days of bleeding per cycle, so may not be a great option if you have heavy periods. They are often not covered by insurance, but they are less than $100, making them very cheap in the long run.
Hormonal IUDs now come in smaller sizes that make placement easier for those who are younger (including teens) and those who have never had a pregnancy. The last 5 or more years and are covered under most drug plans, including OHIP+. Hormonal IUD users like that their periods are often lighter, and about 20-40% will report that their periods stop altogether (this is very safe).
Dr. Costescu places over 200 IUDs a year and complications are very rare. It may help to take some pain relievers just before your insertion appointment. A tip sheet can be found here (link to resources or the sheet itself).
Progestin Implant The Most Effective Method
The newest method of birth control in Canada is the Progestin Implant, and we were one of the first clinics in Canada to place them! This is a single 4cm by 2mm rod that is placed in your non-dominant arm (the one you don’t use to write). It is estrogen-free and lasts for 3-4 years. It is THE most effective method of birth control in Canada, with a failure rate of less than 5 per 10 000 users (that’s 180 times more effective than the pill!).
The implant is inserted in the arm with a bit of freezing anesthetic. To remove it, a small cut is made (also with lots of freezing). We insert and remove Canadian implants, but we can also remove most implants that are used in other countries.
Patients like that this avoids a gyneacological exam doesn’t have to be placed in the uterus, is easy to use, and lowers pelvic pain and menstrual cramps. About 50% of patients report minimal or no bleeding after 6 months. Coverage for the implant is expanding and will be covered by OHIP+ sometime in 2021.
In Ontario, teens can consent to use birth control, including IUDs and Implants, without their parent’s permission. You do not need to ask your parents to use birth control, and we do not have to ask them either.
That said, as a parent, I know that most parents want what is best and safest for their kids. So if your parent wants to come to the appointment, or has questions, you are welcome to bring them along. I cannot talk to your parents without your permission. Most parents feel better after having come to an appointment and learning about the safety of birth control.
If there is another important person in your life that would be a good support to bring to the appointment, please ask them to come! Also, the nurse in the clinic can come for any exam or for the insertion if that makes you feel more comfortable.
Dr. Costescu’s clinics are located in Hamilton Ontario Canada, on Unceded Ancestral Lands of the Haudenosonee and Annishnabeg First Nations.