Ashera is a Marriage and Family Therapist with an extensive background in sexual health education. You can ask her stuff anonymously and she won’t get weirded out. Seriously, try her. Send your queries through our anonymous contact form here.


Hey, Smash!

This might be a little too “medical,” but here’s a current sex-related issue I’ve begun looking into:

So, I’m considering getting back on birth control, after not being on anything for… I dunno, like 7 years or something. The two issues I have: 1) There are a lot more options than there were 7 years ago, right!? Like, what are all the options! What are their pros and cons! I’ve only ever used the straight up Pill.

2) I’m a bit older (almost 40), and I thought I remember reading these horrendous fear-mongering stories about blood clots and the Pill, etc., esp amongst us olds. What’s the reality of this warning? Is it just to shoo us off the Pill and into some manmade structure of womanhood? Or will a blood clot really form in my leg and shoot straight to my lung b/c I don’t wanna have babiez like, ever!? Get out here wit dat! Also (and I still have to go for tests) but I ALSO might be experiencing some wacky estrogen stuff right now, as now is about the time when perimenopause can begin in some, invariably throwing the whole machine outta whack…)

Positing these two things, I ask: is there something out there that might be perfect for a lady like me? A bit older (and MAYBE going through the beginning stages of perimenopause), who wants to ward off unwanted pregnancy, and who does NOT want blood clots. Oh, also I hate condoms. Okay byeee!

– Fluctuating Floozy


Dear Floozy,

First of all, good on you for being proactive about your health. If you’re sexually active and don’t want to make tiny humans, it’s a mad good idea for you to be on some form of birth control. You’re totally right, there are tons more options than there were seven years ago, and there are some that are ideal for women entering perimenopause.

I will preface alllll of this by saying that I am in no way a medical doctor. Anybody interested in starting, stopping, or switching their birth control should 100% take a little stroll down to the clinic and talk to a real live specialist, who will be happy to tell you if you’re a good candidate for any of these forms of BC. Do the research and have the conversations. Don’t do something because some lady on the internet made you feel like it was a good idea.

But first, there are some added health risks that come with age. In my many minutes of googling this, the common consensus seems to be that forms of birth control with increased estrogen are no bueno for women over 35. This goes double if they’re a smoker. The good news is that those with low estrogen or progestin-only can be helpful for women who are entering perimenopause and may even relieve some of the symptoms. No matter what route you go, you’re going to want to have a frank convo with your doc about BC.  Make sure you’re honest (like, really honest not kind of honest) about your sexual history, medical history, eating, smoking, and drinking habits. I know some people like to say they’re only smoking a few cigarettes per week, but are actually smoking half a pack a day. That distinction fucking counts, man. Be real with your MD and they’ll be real with you.

With each potential form of birth control, keep in mind its effectiveness. Is it known to work only under certain circumstances? What causes it to fail? Can it be reversed and how easily? What are the known side effects?  Can it be used to treat other health issues? Very importantly, does it fit into your lifestyle? If you are bad about taking a pill every day, then maybe a longer term option would be better suited for you.

But without further ado, here’s a real quick rundown of some of the best forms of BC:

I know you said you hate condoms, but they are good in a pinch. Also, it’s a good idea to use them if you’re not sure about your partner’s STI status. I wrote a whole primer on making them not suck here.

Short of that, you could consider using a diaphragm. A diaphragm is a little bowl-shaped deal that covers your cervix and prevents sperm from getting anywhere near your eggs.  You put a little spermicide inside it, insert it, and you’re ready to go. You do have to keep it inside you for six hours after sex, but no longer than 24. They take a little practice, but you could throw that mamma jamma in your vagina up to two hours before sex, so you get that spontaneous feeling about the encounter. If you wait more than two hours after inserting, it’s a good idea to re-up on the spermicide.

There are pills out there that are a good option for ladies in their later-thirties/early-forties. Some are progestin-only or just have a real low dose of estrogen.  Some, like Seasonale or Seasonique only have sugar pills every three months, so you only get three periods a year (DOPE!). You do have to take the pill every day at around the same time, or it greatly loses its effectiveness. If you’re not a creature of habit, you may want to look elsewhere.

The arm implant, Nexplanon, is a great form of birth control for a lady on the go. It’s a matchstick-sized rod that is inserted into the upper arm. It’s easily reversible, so if all of a sudden you had the urge to get pregnant, you could get it removed and your hormones would go back to normal pretty quickly. It also keeps you covered for 3-4 years, and may lighten your periods or make them disappear altogether.

Likewise, an IUD is a long-term, reversible form of birth control. Paraguard is hormone-free and lasts up to 12 years. It can cause monsoonesque periods, though. There are IUDs with very light hormones, like Mirena. Those last 3-6 years and can lighten periods greatly. There are some health risks associated with IUDs, but with careful monitoring you can mitigate these greatly.

With all of these, talk to your doctor and make an informed decision.  There’s options out there for everyone.

Keep it freaky, floozy.

Kisses,
Smashera